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Effect of socioemotional stress on the quality of cardiopulmonary resuscitation during advanced life support in a randomized manikin study*

Bjørshol, Conrad Arnfinn MD; Myklebust, Helge BEng; Nilsen, Kjetil Lønne MSc; Hoff, Thomas PhD; Bjørkli, Cato PhD; Illguth, Eirik EMT; Søreide, Eldar MD, PhD; Sunde, Kjetil MD, PhD

doi: 10.1097/CCM.0b013e3181ffe100
Clinical Investigations

Objective: The aim of this study was to evaluate whether socioemotional stress affects the quality of cardiopulmonary resuscitation during advanced life support in a simulated manikin model.

Design: A randomized crossover trial with advanced life support performed in two different conditions, with and without exposure to socioemotional stress.

Setting: The study was conducted at the Stavanger Acute Medicine Foundation for Education and Research simulation center, Stavanger, Norway.

Subjects: Paramedic teams, each consisting of two paramedics and one assistant, employed at Stavanger University Hospital, Stavanger, Norway.

Interventions: A total of 19 paramedic teams performed advanced life support twice in a randomized fashion, one control condition without socioemotional stress and one experimental condition with exposure to socioemotional stress. The socioemotional stress consisted of an upset friend of the simulated patient who was a physician, spoke a foreign language, was unfamiliar with current Norwegian resuscitation guidelines, supplied irrelevant clinical information, and repeatedly made doubts about the paramedics' resuscitation efforts. Aural distractions were supplied by television and cell telephone.

Measurements and Main Results: The primary outcome was the quality of cardiopulmonary resuscitation: chest compression depth, chest compression rate, time without chest compressions (no-flow ratio), and ventilation rate after endotracheal intubation. As a secondary outcome, the socioemotional stress impact was evaluated through the paramedics' subjective workload, frustration, and feeling of realism. There were no significant differences in chest compression depth (39 vs. 38 mm, p = .214), compression rate (113 vs. 116 min−1, p = .065), no-flow ratio (0.15 vs. 0.15, p = .618), or ventilation rate (8.2 vs. 7.7 min−1, p = .120) between the two conditions. There was a significant increase in the subjective workload, frustration, and feeling of realism when the paramedics were exposed to socioemotional stress.

Conclusion: In this advanced life support manikin study, the presence of socioemotional stress increased the subjective workload, frustration, and feeling of realism, without affecting the quality of cardiopulmonary resuscitation.


From the Department of Anaesthesia and Intensive Care Medicine (CAB, EI, ES), Stavanger University Hospital, Stavanger, Norway; Laerdal Medical AS (HM, KLN), Stavanger, Norway; Department of Psychology (TH, CB), University of Oslo, Oslo, Norway; and Surgical Intensive Care Unit (KS), Oslo University Hospital, Ulleval, Oslo, Norway.

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CAB has part-time employment as facilitator at the Stavanger Acute Medicine Foundation for Education and Research. ES is the medical director at Stavanger Acute Medicine Foundation for Education and Research. CAB and ES have received financial support from the Laerdal Foundation for Acute Medicine (grant number 10001). HM and KLN are employees at Laerdal Medical. The remaining authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins