Key result
Cognitive workload, as measured by heart rate variability and self-report, was highest for perfusionists during the preclamp phase of cardiopulmonary bypass compared to other surgical phases.
Why the study?
Investigation into dynamic cognitive workload fluctuations among perfusionists operating the CPB pump during open-heart surgery, and their relationship with performance, is lacking.
Observational (n=3)
No
Continuous physiological monitoring reveals that cardiac perfusionists experience peak cognitive workload during the preclamp phase of cardiopulmonary bypass, highlighting a critical period of vulnerability during cardiac surgery.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for phase-specific monitoring in perfusionists; prospective trials needed before practice change.
OBJECTIVE: This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. BACKGROUND: Estimations of operators' cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient's homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. METHOD: = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. RESULTS: Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. CONCLUSION: We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. APPLICATION: These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.
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Kennedy-Metz et al. (2020) conducted an observational in Cognitive workload during cardiac surgery (n=3). Cardiopulmonary bypass pump operation phases (specifically preclamp phase) vs. Pre- and postbypass phases, and other bypass phases (clamp, postclamp) was evaluated on Dynamic changes in heart rate variability (HRV) components and self-reported cognitive workload (SURG-TLX). Cognitive workload, as measured by heart rate variability and self-report, was highest for perfusionists during the preclamp phase of cardiopulmonary bypass compared to other surgical phases.
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