[On the Basis of the DeGIR/DGNR Register Nationwide Care for Acute Ischemic Stroke Patients in 2016 and 2017 Using Mechanical Thrombectomy by Radiologists and Neuroradiologists]

Differences in beginner and expert neurointerventionalists" heart rate variability during simulated neuroangiographies

BACKGROUND

Likewise work experience, heart rate variability (HRV) has repeatedly been correlated with improved performance under real life and simulator conditions. Using HRV as a correlate of workload, it is meaningful to assess the impact of work experience. To understand the impact of work experience on HRV metrics, we examined differences in HRV among experts and beginners during simulated endovascular neuroradiological procedures.

METHODS

Six inexperienced radiologists (beginners) and five experts in neurological endovascular intervention each performed 10 diagnostic angiographies on a Vascular Interventional System Trainer (VIST) simulator (Mentice AB, SW). Beyond total time, fluoroscopy time, and amount of contrast medium used, heart rate variability and the NASA-task load index were gathered as correlates of workload. The t-Test for independent samples as well as Mann-Whitney-U tests were applied for group-wise comparison between beginners and experts. Multivariate regression was used to assess the influence of age and expert status.

RESULTS

Ten participants completed all scenarios; one participant only completed the first five scenarios. Accordingly, 105 simulations were analyzed (beginners N = 60; experts N = 45, respectively). The heart rate variability of experts and beginners significantly differed in three time domain HRV metrics (decreased RMSSD, NN50, pNN50 in experts; all p < 0.05) as well as with respect to its distribution in the frequency spectrum (LF/HF ratio; p < 0.001, increased high frequency components in experts).

CONCLUSIONS

The HRV of beginners and expert neurointerventionalists significantly differed during simulated endovascular neuroradiological procedures. Experts presented decreased HRV, this could be a cardiovascular surrogate to the effort the subjects expend on their performance. It is in line with previous studies on vagal influences on the heart and cognitive-executive performance.

[Structures of endovascular recanalization in Germany : Cross-sectional survey of certified stroke units 2016-2018]

In this cross-sectional study data from 299 certified stroke units (SU) in Germany were analyzed from January 2016 to December 2018 and included comprehensive stroke centers (CSC 34%), local SU (62%), and telemedical SU (4%). In a total of 2487 SU monitor beds, 251,539 cases of stroke treatment were documented. The number of monitor beds (10.8 vs. 7.2) and stroke cases per year (1143 vs. 708) were significantly higher in CSC than in local SU. A total of 9251 endovascular recanalization (ER) procedures were performed annually by 475 interventionalists. The overall rate of ER was 3.7% of all stroke cases, including intracerebral hemorrhage (ICH) and transient ischemic attacks (TIA). A total of 124 of the SUs (41.5%) had a 24/7 ER structure in which 55% of all stroke treatments and 96% of all ERs were carried out. In the vast majority of CSC the ER structure was robust (≥4 interventionalists, 52%) or acceptable (3 interventionalists, 27%). In contrast, the majority of local SU (88%) had to transfer patients for ER over average distances of 40 km (range 1-160 km). Overall, the ER structures in Germany between 2016 and 2018 could be described as good to very good.