Oral Themed Presentation


Evolution of autonomic nervous system parameters during repetitive immersive simulations over one year

Tuesday, May 15
11:00 - 12:30
Location: Jupiter 1&2

Background: : It is well-established that stress increases during High-fidelity simulations (HFS) [1]. However, to our knowledge no research has studied the impact over time of repetitive immersive simulation on the daily lives of trainees.

Research Question: : 1) Autonomic Nervous System (ANS) evolution on 24-hour Holter monitoring during daytime simulations over one year; 2) Analysis of the effect of repetitive HFS on the risk of post-traumatic stress disorder (PTSD).

Methodology: : IRB approval by the University Hospital of Poitiers, France, and INSERM-CIC 1402 (Research Institute). RCT number: NCT02424890.19. 48 participants were randomized in 12 MDTs of French EMS (4 members: physician/PGY/nurse/ambulance driver). MDTs were randomized in 2 groups to manage infant shock in HFS. In the experimental group 6 MDTs were exposed to 9 different scenarios over 1 year. In the control group, 6 MDTs had only 3 scenarios, which were common to those of the experimental group (initial, intermediate after 6 months and final after 1 year) [2]. Questionnaires of IES-R at 7 days [3] and PCLS at 1 month [4] were used to track participant PTSD. Heart rate (HR) and heart rate variability in time domain (pNN50) and spectral domain (LF/HF ratio) were analyzed on a 24-hour Holter monitoring from the day prior to the simulations until the end of the simulation. ANOVA was used to compare the evolution of Holter parameters during the diurnal and nocturnal periods, and over the 24 hours between the two groups. p <0.05 was considered significant.

Results: : IES-R and PCLS were analyzed for the 48 participants during the 72 simulation sessions. Nobody developed PTSD. There was no difference between the two groups during the initial scenario in terms of HR and HRV. During the intermediate and final scenarios, however, the level of stress was higher in the control group. There was a group and a time effect on HRV in spectral domain in the diurnal period (p=0.04) and the nocturnal period (p=0.01) after repetitive HFS.

Discussion/Conclusions: : Despite the stress generated by the simulation, it seems that repetition of the simulations does not lead to PTSD in the participants. On the other hand, the more the sessions are repeated and the less are the repercussions on the daily lives of the participants, reflected by a lower activity of the ANS.

Daniel Aiham Ghazali

Simulation Center, University of Paris-Diderot, Paris, France

Dr Daniel Aïham GHAZALI, MD, PhD
Emergency Department and EMS, University Hospital of Bochat, Paris, France
Simulation Center of Paris-Diderot University, Paris, France

Post Doctorate in SImulation
Reserach on teamwork and relationship between stress and performance

Teaching in the University of Poitiers (Pediatric Emergency) and in the University of Paris-Diderot (Emergency)

Publications in Education, Emergency, Critical care, and Pediatric journals


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Catherine Allan, MD

Associate Program Director - Simulator Program
Boston Children's Hospital
Boston, Massachusetts

Catherine Allan, MD is the Associate Program Director of the Simulator Program and Medical Director of the Cardiac Intensive Care Unit at Boston Children’s Hospital. Over the last 10 years she has helped to develop a robust, interdisciplinary program in ECMO Simulation at Boston Children’s Hospital. Dr. Allan has translated this model to other insitutions on both a National and International level to help these programs build new clinical ECMO Programs. She has published on the use of ECMO Simulation Skills Training and on clinical outcomes following ECMO support in the congenital heart disease population and has presented on ECMO simulation at multiple National and International Meetings.


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Evolution of autonomic nervous system parameters during repetitive immersive simulations over one year

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