ST-T Segment Changes in Emergency Physicians While on Duty

Preclinical emergency management is frequently associated with a combination of physical and psychological stress.

This stress is known to lead to a broad variety of changes in the physiology even extending in the cardiovascular system. Both physical and psychological stress induces ECG changes. These changes include not only arrhythmias but also deviations in ST-T segment representing the phase of repolarization.

Information about changes in ST-T segment are missing until now. The investigators hypothesise that ST-T deviations occur in emergency physicians during shift at an emergency response car.

In order to show changes in ST-T segment a prospective observational trial will be conducted. By using a 12 lead ECG Holter the investigators will obtain ECGs during shifts of emergency physicians at an emergency response vehicle.

During 12-hour shifts emergency physicians will be attached to the 12 lead Holter ECG. ECGs will be analysed after blinding of names and reason of call (code) to the investigators. The primary outcome will be ST-T segment changes greater than 0.1mV in two corresponding leads for more than 30 seconds per 100 calls.

As secondary outcomes, other ECG changes such as ST-T segment changes <0.1mV, T wave inversion or HRV will be analysed. Furthermore, surrogate parameter of stress will be measured using NASA-Task Load Index and cognitive appraisal and correlated to ST-T segment changes. Correlations between different phases of calls, different indications of calls and ECG changes will be assessed. Furthermore, correlation between alarm codes apriori defined as stressfull using a delphi process and ST-T segment changes as well es surrogate parameters of stress will be assessed.

Study Overview

• Status: Completed
• Conditions: ST-T Segment Changes
• Intervention / Treatment: Device: Holter ECG

• Study Type: Observational
• Enrollment (Actual): 25

Contacts and Locations

Study Locations

• Austria
  • Vienna, Austria, 1090
    • Medical University of Vienna

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 68 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Emergency physicians working at the Medical University of Vienna's emergency response cars will be invited to take part in this trial. Participants will be recruited by personalised phone contact, via email or direct approach and will not financially benefit for participation. The emergency physicians are anaesthesiologists and emergency medicine consultants and senior anaesthesia or emergency medical residents with prehospital emergency medicine credentials.

Description

Inclusion Criteria:

• Healthy emergency physicians doing shifts at the Medical University of Vienna's emergency response car

Exclusion Criteria:

• Known pregnancy
• Pre-existing cardiac diseases (valvular heart disease > I°, any form of cardiomyopathy, history of coronary artery disease, history of myocarditis, any channelopathy, known high degree (>1% of all beats within 24h) premature atrial or ventricular beats or atrial fibrillation or conduction disturbance.
• Any antiarrhythmic therapy
• Any implanted cardiac device
• Manifest Hyperthyroidism
• Termination of exercise testing due to the commonly used criteria26 or not reaching 85% of maximal predicted load.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Emergency physicians; Emergency physicians doing shifts at the Medical University of Vienna's emergency response car will recieve a thorough cardiac pretesting. During shifts they will be attached to a Holter-ECG to detect changes in ST-T Segment and other ECG changes. Furthermore surrogate parameters of stress will be measured	Device: Holter ECG; A Holter ECG will be recorderd during shifts

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ST-T segment change	ST-T segment changes of at least 0.1mV in two corresponding leads occurring for more than 30 seconds per 100 prehospital emergency response calls	Day1-3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ST-T segment change <0.1mV, <30sec.		Day1-3
T wave inversion > 30sec.		Day1-3
T wave inversion <= 30sec.		Day1-3
Changes in HRV	Changes in HRV (SDNN, r-MSSD and pNN50) during calls compared to a baseline of 10min rest recorded at the beginning of shift as an emergency physician	Day1-3
Association of different phases of a call to changes in ST-T segments > 0.1mV in two corresponding leads for > 30sec.		Day1-3
Association of different phases of a call to changes in HRV (SDNN, r-MSSD and pNN50)		Day1-3
Association of the ten most stressful alarm codes to changes in ST-T segments > 0.1mV in two corresponding leads for > 30sec.		Day1-3
Association of the ten most stressful alarm codes to changes in HRV (SDNN, r-MSSD and pNN50)		Day1-3
Psychological stress during calls by means of NASA TLX		Day1-3
Frequency of calls being perceived as threat by using cognitive appraisal testing		Day1-3
Association of stressful and non-stressful calls to psychological stress measured using NASA TLX		Day1-3
Association of stressful and non-stressful calls to cognitive appraisal and calls that are perceived as threat.		Day1-3
Correlation of events logged	Correlation of events logged by the emergency physician (treating a child, managing polytrauma, being woken up by the alarm, experiencing chest pain, performing an intubation or giving i.v. medication) to ST-T segment changes > 0.1mV in two corresponding leads for > 30sec.	Day1-3
Association of NASA TLX to ST-T segment changes > 0.1mV in two corresponding leads for > 30sec.		Day1-3
Association of cognitive appraisal to ST-T segment changes > 0.1mV in two corresponding leads for > 30sec.		Day1-3

Collaborators and Investigators

• Sponsor: Medical University of Vienna
• Investigators: Principal Investigator: Mathias Maleczek, MD, Medical University of Vienna

Publications and helpful links

General Publications

• Maleczek M, Schebesta K, Hamp T, Burger AL, Pezawas T, Krammel M, Roessler B. ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial. Scand J Trauma Resusc Emerg Med. 2022 Jul 15;30(1):47. doi: 10.1186/s13049-022-01033-1.

Study record dates

Study Major Dates

• Study Start (ACTUAL): November 1, 2019
• Primary Completion (ACTUAL): May 1, 2021
• Study Completion (ACTUAL): November 30, 2021

Study Registration Dates

• First Submitted: June 25, 2019
• First Submitted That Met QC Criteria: June 28, 2019
• First Posted (ACTUAL): July 1, 2019

Study Record Updates

• Last Update Posted (ACTUAL): February 15, 2022
• Last Update Submitted That Met QC Criteria: February 13, 2022
• Last Verified: February 1, 2022

More Information

Terms related to this study

• Keywords: stress; occupational health; emergency medicine; ST segment; preclinical emergency medicine; 24h ECG
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 1646/2019

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No