Medical Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland.
BMC Emerg Med. 2013 Apr 22;13:8. doi: 10.1186/1471-227X-13-8.
Cardiopulmonary resuscitation (CPR) causes significant stress for the rescuers which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario.
This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive a 10 minute instruction to cope with stress by loudly posing two task-focusing questions ("what is the patient's condition?", "what immediate action is needed?") when feeling overwhelmed by stress (intervention group) or a control group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements.
Participants in the intervention group reported significantly less stress/overload levels compared to the control group (mean difference: -0.6 (95% CI -1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was longer in the intervention- group, but the difference was not statistically significant (difference 5.5 (95% CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95% CI -8.4, 5.7), p=0.71).
A brief stress-coping strategy moderately decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress.
NCT01645566.
心肺复苏（CPR）会给施救者带来很大的压力，可能导致注意力不集中和分散注意力增加。这可能导致对优先事项的判断失误和 CPR 执行延迟，从而进一步增加心理压力（恶性循环）。本研究评估了一种专注于任务的策略对模拟 CPR 场景中感知压力水平和表现的影响。
这是一项在瑞士巴塞尔大学医院模拟中心进行的前瞻性、随机对照试验。共有 124 名志愿医学生被随机分为两组，一组在感到压力过大时大声提出两个专注于任务的问题（“患者的情况如何？”，“需要立即采取什么行动？”），接受 10 分钟应对压力的指导（干预组），另一组为对照组。主要结局是感知压力水平和感到不知所措（压力/过载）；次要结局是实际操作时间、开始 CPR 的时间和领导陈述的次数。
与对照组相比，干预组的参与者报告的压力/过载水平明显较低（平均差异：-0.6（95%CI-1.3，-0.1），p=0.04）。较高的压力/过载与实际操作时间较短有关。两组之间的领导陈述没有差异，但领导陈述的次数与表现有关。干预组的实际操作时间较长，但差异无统计学意义（差异 5.5（95%CI-3.1，14.2），p=0.2）；开始 CPR 的时间无差异（差异-1.4（95%CI-8.4，5.7），p=0.71）。
简短的应对压力策略可适度降低感知压力，但对模拟 CPR 中的表现无显著影响。进一步的研究应探讨减少压力的更强烈干预措施。
NCT01645566。
