Medical Intensive Care Unit, University Hospital Basel, Basel, Switzerland.
Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
PLoS One. 2018 Jun 14;13(6):e0198661. doi: 10.1371/journal.pone.0198661. eCollection 2018.
Performance of cardiopulmonary resuscitation (CPR) causes significant mental stress for rescuers, especially if performed by inexperienced individuals. Our aim was to study electrocardiogram (ECG) alterations in rescuers and its association with gender and CPR performance.
We included 126 medical students in this prospective, observational simulator study. Each student was equipped with a 3-lead continuous ECG device tracking the individual electrocardiographic output before, during and after CPR. We analyzed variations in heart rate, heart-rate variability (HRV) and ST- and T-wave morphology.
Compared to baseline, mean heart rate (bpm) significantly increased during resuscitation and again decreased after resuscitation (from 87 to 97 to 80, p<0.001). Heart-rate variability (the standard deviation of all N-N intervals, SDNN) (ms2) showed the opposite pattern, decreasing during resuscitation and increasing after resuscitation (117 to 92 to 93ms, p<0.001). Abnormalities in T-waves and ST-segments were observed in 29.4% of participants. Maximal heart rate (r = 0.25, p = 0.046) as well as heart rate reactivity (r = 0.7, p<0.001) correlated with hands-on time, a measure of CPR performance. Compared to males, female rescuers had a significantly higher maximal heart rate (136bpm vs. 126bpm, p = 0.008) and lower HRV (SDNN 102 vs. 119ms, p = 0.004) and tended to show more abnormalities in T-waves and ST-segments (36% vs. 21%, p = 0.080).
CPR causes significant ECG alterations in healthy medical students with ST-segment and T-wave abnormalities, with more pronounced effects in females. Clinical implications of these findings need to be further investigated.
心肺复苏术（CPR）的实施会给施救者带来巨大的精神压力，尤其是对经验不足的施救者而言。我们的目的是研究施救者心电图（ECG）的变化及其与性别和 CPR 表现的关系。
我们纳入了 126 名医学生参与这项前瞻性、观察性模拟研究。每位学生均配备了一个 3 导联连续 ECG 设备，在 CPR 之前、期间和之后跟踪个体心电图输出。我们分析了心率、心率变异性（HRV）和 ST 波及 T 波形态的变化。
与基线相比，复苏过程中平均心率（bpm）显著增加，复苏后再次降低（从 87 增加到 97 再到 80，p<0.001）。心率变异性（所有 NN 间期的标准差，SDNN）（ms2）呈现相反的模式，在复苏过程中降低，复苏后增加（从 117 降低到 92 再到 93ms，p<0.001）。29.4%的参与者出现 T 波和 ST 段异常。最大心率（r = 0.25，p = 0.046）和心率反应性（r = 0.7，p<0.001）与上手时间相关，上手时间是 CPR 表现的一个衡量指标。与男性相比，女性施救者的最大心率显著更高（136bpm 比 126bpm，p = 0.008），HRV 更低（SDNN 102 比 119ms，p = 0.004），并且更倾向于出现 T 波和 ST 段异常（36%比 21%，p = 0.080）。
CPR 会导致健康医学生的心电图发生显著变化，出现 ST 段和 T 波异常，女性的影响更为明显。这些发现的临床意义需要进一步研究。
