Working memory capacity and surgical performance whilst exposed to mild hypoxic hypoxaemia (3000m)

INTRODUCTION: Medical Emergency Response Team (MERT) helicopters fly at altitudes of 3,000m in Afghanistan (9,843ft). Civilian hospitals and disaster-relief surgical teams may have to operate at such altitudes or even higher. Mild hypoxia has been seen to affect the performance of novel tasks at flight levels as low as 5,000ft. Aeromedical teams frequently work in unpressurised environments; it is important to understand the implications of this mild hypoxia and investigate whether supplementary oxygen systems are required for some or all of the team members. METHODS: Ten UK orthopaedic surgeons were recruited and in a double blind randomised experimental protocol, were acutely exposed for 45 minutes to normobaric hypoxia (fraction of inspired oxygen (FiO2) ~14.1% - equivalent to 3000m/10,000ft) or normobaric normoxia (sea-level). Basic physiological parameters were recorded. Subjects completed validated tests of verbal working memory capacity (VWMC) and also applied an orthopaedic external fixator (Hoffmann® 3, Stryker UK) to a plastic tibia under test conditions. RESULTS: Significant hypoxia was induced with the reduction of FiO2 to ~14.1% (SpO2 87% vs. 98%). No effect of hypoxia on VWMC was observed. The pin-divergence score (a measure of frame asymmetry) was significantly greater in hypoxic conditions (4.6mm) compared to sea level (3.0mm), there was no significant difference in the penetrance depth (16.9 vs. 17.2mm). One frame would have failed early. DISCUSSION: We believe that surgery at an altitude of 3000m when unacclimated individuals are acutely exposed to atmospheric hypoxia for 45 minutes, can likely take place without supplemental oxygen use but further work is required.