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Observational Study
. 2022 Jul 15;30(1):47.
doi: 10.1186/s13049-022-01033-1.

ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial

Mathias Maleczek  1   2 , Karl Schebesta  3   4 , Thomas Hamp  1 , Achim Leo Burger  5 , Thomas Pezawas  5 , Mario Krammel  6   7 , Bernhard Roessler  1   2
Affiliations
Observational Study

ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial

Mathias Maleczek et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Aims: Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.

Methods: In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed.

Results: Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index.

Conclusion: ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2.

Keywords: Critical care; Emergency; Prehospital; ST-T segment; Stress.

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Conflict of interest statement

The Authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Prisma flowchart. A Prisma flowchart of the participants including dropouts is shown
Fig. 2
Fig. 2
Distribution of ECG changes. The distribution of ECG changes between phases of a mission is shown. En-route is driving to the patient, patient care is the time between arrival on scene and start of patient transport
Fig. 3
Fig. 3
Differences in NASA-TLX. The boxplot on the left shows NASA-TLX of a mission by any ECG change occurring during patient care. The boxplot on the right shows NASA-TLX classified by most stressful alarm codes as defined by a Delphi process
See this image and copyright information in PMC

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