The Impact of Stress and Distraction on Bag-Valve-Mask Ventilation Performance

Area of Science:

• Medical Simulation
• Emergency Medicine
• Human Physiology

Background:

• Emergency departments (EDs) present inherent stressors and distractions.
• These environmental factors can physiologically affect healthcare providers.
• Such physiological changes may impair performance in critical procedures like bag-valve-mask (BVM) ventilation.

Purpose of the Study:

• To evaluate the physiological impact of stress and distraction on emergency medicine (EM) residents.
• To assess the effect of these factors on BVM ventilation performance.
• To determine if stress or distraction leads to greater performance decrements.

Main Methods:

• Four EM residents participated in a simulation with baseline, stress, and distraction phases.
• Physiological data (heart rate, electrodermal activity) were monitored using wearable sensors.
• Bag-valve-mask (BVM) ventilation performance was recorded using a high-fidelity manikin, measuring ventilation rate and inspiratory pressure.

Main Results:

• Ventilation rate decreased during distraction (11.9/min) compared to stress (16/min) and baseline (12.5/min).
• Peak inspiratory pressure increased significantly under stress (24.4 cmH2O/mL) and distraction (22.3 cmH2O/mL) versus baseline (15.5 cmH2O/mL).
• Physiological responses, including heart rate and electrodermal activity, showed greater deviation from baseline during the distraction phase for most residents.

Conclusions:

• Both stress and distraction significantly impact EM residents' physiology and BVM performance.
• The stress phase resulted in the most substantial decrements in BVM ventilation performance.
• The distraction phase elicited a more pronounced physiological stress response.