Heart rate variability and physician performance during airway management simulations: an exploratory pilot study

Abstract Objective To examine the association between heart-rate variability (HRV) and physician performance during airway management simulations in two physician cohorts studied under different HRV measurement conditions. Methods This exploratory pilot study included otolaryngologists and anesthesiologists participating in two high-fidelity airway simulation courses. HRV was measured via finger-mounted optical sensor and expressed as RMSSD. In one cohort, HRV was recorded immediately before simulation (pre-task); in the second, several days prior (baseline). Blinded supervisors rated performance on standardized 10-point Likert scales. Pearson and exploratory partial correlations adjusting for age, years in practice, and self-reported stress were calculated. Results Twenty-five physicians participated (17 males, 8 females; mean age 35.9 ± 4.7 years). The cohorts differed significantly in age, clinical experience, and performance scores. In the pre-task cohort (n = 11), lower HRV was associated with higher performance (Log RMSSD unadjusted r = −0.73, 95% CI [−0.927, −0.244]; adjusted r = −0.85, 95% CI [−0.97, −0.46]). In the baseline cohort (n = 14), higher HRV was associated with higher performance (Log RMSSD unadjusted r = 0.53, 95% CI [0.055, 0.845]; adjusted r = 0.73, 95% CI [0.198, 0.933]). Wide confidence intervals reflect the small samples and these estimates should be interpreted cautiously. No associations were observed between self-reported stress and either HRV or performance. Conclusion HRV was associated with physician performance during airway management simulations, with differing directions of association observed in two physician cohorts studied under different measurement conditions. These findings are exploratory and hypothesis-generating and require confirmation in larger standardized within-subject studies.