title: Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial.
abstract: BACKGROUND
  Cardiopulmonary resuscitation (CPR) causes significant stress for the rescuers which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario.
  
  
  METHODS
  This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive a 10 minute instruction to cope with stress by loudly posing two task-focusing questions ("what is the patient's condition?", "what immediate action is needed?") when feeling overwhelmed by stress (intervention group) or a control group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements.
  
  
  RESULTS
  Participants in the intervention group reported significantly less stress/overload levels compared to the control group (mean difference: -0.6 (95% CI -1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was longer in the intervention- group, but the difference was not statistically significant (difference 5.5 (95% CI -3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference -1.4 (95% CI -8.4, 5.7), p=0.71).
  
  
  CONCLUSIONS
  A brief stress-coping strategy moderately decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress.
  
  
  BACKGROUND
  NCT01645566.
authors.affiliation: Medical Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland. sabinahunziker@gmail.com
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
authors.forename: Simona
authors.initials: S
authors.lastname: Pagani
authors.forename: Katrin
authors.initials: K
authors.lastname: Fasler
authors.forename: Franziska
authors.initials: F
authors.lastname: Tschan
authors.forename: Norbert K
authors.initials: NK
authors.lastname: Semmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007857:Leadership; D008297:Male; D008348:Manikins; D011446:Prospective Studies; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology*; D013557:Switzerland; D013663:Teaching / Q000379:methods*