{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:02:12Z","timestamp":1787018532524,"version":"build-2736575974"},"reference-count":60,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hum Factors"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate, under replicable, blinded and standardised conditions, the effect of acute exposure to hypobaric hypoxia (HH) (equivalent to 200 or 3000 or 5000\u00a0m above sea level (asl)) on selected cognitive domains and physiological parameters in personnel of helicopter emergency medical service (HEMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a randomized clinical trial using a single-blind crossover design in an environmental chamber (\n                      <jats:italic>terraXcube<\/jats:italic>\n                      ) to induce HH in 48 HEMS personnel. Participants performed cognitive tests (CT) before the ascent, after 5 min at altitude, and after simulated cardiopulmonary resuscitation (SCR). CT evaluated: sustained attention using the psychomotor vigilance test (PVT) that included measurement of reaction time (RT); risky decision making using the balloon analogue risk task (BART), and attention and speed of processing using the digit symbol substitution test (DSST). CT performance was subjectively rated with a visual analogue scale (VAS). Physiological data were recorded with a physiological monitoring system. Data were analysed using a linear mixed model and correlation analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean reaction time was significantly slower (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002) at HH (5000 m asl), but there were no independent effects of HH on the other parameters of the PVT, BART or DSST. Participants did not detect subjectively the slower RT at altitude since VAS performance results showed a positive correlation with mean RT (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009). DSST results significantly improved (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001) after SCR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Acute exposure of HEMS personnel to HH induced a slower RT but no changes in any other investigated measures of cognition. The reduced RT was not detected subjectively by the participants. Trial number 3489044136, ClinicalTrials.gov trial registration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00187208221086407","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T18:51:15Z","timestamp":1654023075000},"page":"404-423","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["Simulated Acute Hypobaric Hypoxia Effects on Cognition in Helicopter Emergency Medical Service Personnel \u2013 A Randomized, Controlled, Single-Blind, Crossover Trial"],"prefix":"10.1177","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7477-3020","authenticated-orcid":false,"given":"Marika","family":"Falla","sequence":"first","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, Center for Mind\/Brain Sciences, CIMeC, University of Trento, Rovereto (TN), Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"H\u00fcfner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Falk","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"V\u00f6gele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"Jan van Veelen","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Brandner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Palma","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Dejaco","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2752-6929","authenticated-orcid":false,"given":"Hermann","family":"Brugger","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4402-8633","authenticated-orcid":false,"given":"Giacomo","family":"Strapazzon","sequence":"additional","affiliation":[{"name":"Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy, International Commission for Alpine Emergency Medicine (ICAR MEDCOM), Kloten, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0063630"},{"key":"e_1_3_4_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/sms.13573"},{"key":"e_1_3_4_4_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.3661.2013"},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actaastro.2011.07.015"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.3357\/AMHP.4343.2015"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219087"},{"key":"e_1_3_4_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/36.5.591"},{"key":"e_1_3_4_9_1","doi-asserted-by":"publisher","DOI":"10.3357\/AMHP.5022.2018"},{"key":"e_1_3_4_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2017.0160"},{"key":"e_1_3_4_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/00140139.2018.1510541"},{"key":"e_1_3_4_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(89)90047-4"},{"issue":"2","key":"e_1_3_4_13_1","first-page":"169","article-title":"In-flight hypoxia incidents in military aircraft: Causes and implications for training","volume":"74","author":"Cable G. G.","year":"2003","unstructured":"Cable G. G. (2003). In-flight hypoxia incidents in military aircraft: Causes and implications for training. Aviation, Space, and Environmental Medicine, 74(2), 169\u2013172.","journal-title":"Aviation, Space, and Environmental Medicine"},{"key":"e_1_3_4_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1993.tb04085.x"},{"key":"e_1_3_4_15_1","volume-title":"The Social Psychology of Health","author":"Cohen S.","year":"1988","unstructured":"Cohen S., Williamson G. (1988). Perceived stress in a Probability sample of the United States. In Spacapan S., Oskamp S. (eds), The Social Psychology of Health. Sage."},{"key":"e_1_3_4_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2016.06.001"},{"key":"e_1_3_4_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00806"},{"issue":"4","key":"e_1_3_4_18_1","first-page":"267","article-title":"Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4\u20135 hours per night","volume":"20","author":"Dinges D. F.","year":"1997","unstructured":"Dinges D. F., Pack F., Williams K., Gillen K. A., Powell J. W., Ott G. E., Aptowicz C., Pack A. I. (1997). Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4\u20135 hours per night. Sleep, 20(4), 267\u2013277.","journal-title":"Sleep"},{"key":"e_1_3_4_19_1","doi-asserted-by":"publisher","DOI":"10.3758\/BF03200977"},{"key":"e_1_3_4_20_1","unstructured":"EASA (2018). https:\/\/www.easa.europa.eu\/document-library\/notices-of-proposed-amendment\/npa-2018-04"},{"issue":"13","key":"e_1_3_4_21_1","article-title":"Recommendations for traveling to altitude with neurological disorders","volume":"20","author":"Falla M.","year":"2021","unstructured":"Falla M., Giardini G., Angelini C. (2021). Recommendations for traveling to altitude with neurological disorders. J Cent Nerv Syst Dis, 20(13). https:\/\/doi.org\/10.1177\/11795735211053448. 34955663","journal-title":"J Cent Nerv Syst Dis"},{"key":"e_1_3_4_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.670278"},{"key":"e_1_3_4_23_1","volume-title":"The psychological effects of concussion","author":"Gronwall D.","year":"1974","unstructured":"Gronwall D., Sampson H. (1974). The psychological effects of concussion. Auckland University Press."},{"issue":"14","key":"e_1_3_4_24_1","doi-asserted-by":"crossref","first-page":"e0217089","DOI":"10.1371\/journal.pone.0217089","article-title":"Cognitive function and mood at high altitude following acclimatization and use of supplemental oxygen and adaptive servoventilation sleep treatments","volume":"12","author":"Heinrich E. C.","year":"2019","unstructured":"Heinrich E. C., Djokic M. A., Gilbertson D., DeYoung P. N., Bosompra N. O., Wu L., Anza-Ramirez C., Orr J. E., Powell F. L., Malhotra A., Simonson T. S. (2019). Cognitive function and mood at high altitude following acclimatization and use of supplemental oxygen and adaptive servoventilation sleep treatments. Plos One, 12(14), e0217089. https:\/\/doi.org\/10.1371\/journal.pone.0217089.","journal-title":"Plos One"},{"issue":"11","key":"e_1_3_4_25_1","first-page":"e0146290","article-title":"Cognitive changes during prolonged stay at high altitude and its correlation with c-reactive protein","volume":"5","author":"Hu S. L.","year":"2016","unstructured":"Hu S. L., Xiong W., Dai Z. Q., Zhao H. L., Feng H. (2016). Cognitive changes during prolonged stay at high altitude and its correlation with c-reactive protein. Plos One, 5(11), e0146290. https:\/\/doi.org\/10.1371\/journal.pone.0146290.","journal-title":"Plos One"},{"key":"e_1_3_4_26_1","volume-title":"Helicopter instrument straight climbs","author":"International Virtual Aviation Organization IVAO","year":"2020","unstructured":"International Virtual Aviation Organization IVAO (2020). Helicopter instrument straight climbs. Instrument Flying Handbook FAA-H-8083-15B. Galmaarden, Belgium: 2020, available from URL. https:\/\/www.ivao.aero (last accessed 287 20)."},{"key":"e_1_3_4_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.185"},{"key":"e_1_3_4_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2020.04.004"},{"key":"e_1_3_4_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2014.11.057"},{"key":"e_1_3_4_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/001872089303500208"},{"key":"e_1_3_4_31_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3242"},{"key":"e_1_3_4_32_1","doi-asserted-by":"publisher","DOI":"10.3233\/WOR-2012-0156-198"},{"key":"e_1_3_4_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2015.10.002"},{"key":"e_1_3_4_34_1","doi-asserted-by":"publisher","DOI":"10.1037\/1076-898X.8.2.75"},{"issue":"138","key":"e_1_3_4_35_1","first-page":"1521","article-title":"A two-step rejection procedure for testing multiple hypotheses","author":"Li J.","year":"2007","unstructured":"Li J. (2007). A two-step rejection procedure for testing multiple hypotheses. Journal of Statistical Planning and Inference, (138), 1521-1527.","journal-title":"Journal of Statistical Planning and Inference"},{"issue":"4","key":"e_1_3_4_36_1","first-page":"235","article-title":"Effects of acute exposure to mild or moderate hypoxia on human psychomotor performance and visual-reaction time","volume":"13","author":"Li X. Y.","year":"2000","unstructured":"Li X. Y., Wu X. Y., Fu C., Shen X. F., Yang C. B., Wu Y. H. (2000). Effects of acute exposure to mild or moderate hypoxia on human psychomotor performance and visual-reaction time. Space Med Med Eng (Beijing), 13(4), 235\u2013239.","journal-title":"Space Med Med Eng (Beijing)"},{"key":"e_1_3_4_37_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.02128"},{"key":"e_1_3_4_38_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0205285"},{"key":"e_1_3_4_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci9110323"},{"key":"e_1_3_4_40_1","doi-asserted-by":"publisher","DOI":"10.3357\/ASEM.3482.2013"},{"key":"e_1_3_4_41_1","doi-asserted-by":"crossref","unstructured":"McMorris T Hale B. J Barwood M Costello J Corbett J (2017). Effect of acute hypoxia on cognition: A systematic review and meta-regression analysis. Neurosci Biobehav RevErratum in. Neurosci Biobehav Rev (74) 98 225333\u2013232 . https:\/\/doi.org\/10.1016\/j.neubiorev.2017.01.019","DOI":"10.1016\/j.neubiorev.2019.01.017"},{"key":"e_1_3_4_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bandc.2012.09.001"},{"key":"e_1_3_4_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2010.12.007"},{"key":"e_1_3_4_44_1","doi-asserted-by":"publisher","DOI":"10.1037\/bne0000288"},{"key":"e_1_3_4_45_1","doi-asserted-by":"publisher","DOI":"10.5014\/ajot.57.5.570"},{"issue":"76","key":"e_1_3_4_46_1","first-page":"28","article-title":"Cognitive and emotional processing at high altitude","author":"Pavlicek V.","year":"2015","unstructured":"Pavlicek V., Schirlo C., Nebel A., Regard M., Koller E. A., Brugger P. (2015). Cognitive and emotional processing at high altitude. Aviation, Space, and Environmental Medicine, (76), 28-33.","journal-title":"Aviation, Space, and Environmental Medicine"},{"key":"e_1_3_4_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2012.05.007"},{"key":"e_1_3_4_48_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-018-0490-5"},{"key":"e_1_3_4_49_1","doi-asserted-by":"publisher","DOI":"10.1080\/10253890.2019.1680634"},{"key":"e_1_3_4_50_1","doi-asserted-by":"publisher","DOI":"10.3109\/10253890.2014.891103"},{"key":"e_1_3_4_51_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21155569"},{"key":"e_1_3_4_52_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2018.00677"},{"key":"e_1_3_4_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNR.0000000000000169"},{"key":"e_1_3_4_54_1","doi-asserted-by":"publisher","DOI":"10.1089\/ham.2017.0164"},{"issue":"6","key":"e_1_3_4_55_1","first-page":"372","article-title":"The impact of different environmental conditions on cognitive function: A focused review","author":"Taylor L.","year":"2016","unstructured":"Taylor L., Watkins S. L., Marshall H., Dascombe B. J., Foster J. (2016). The impact of different environmental conditions on cognitive function: A focused review. Front Physiol, (6), 372. https:\/\/doi.org\/10.3389\/fphys.2015.00372.","journal-title":"Front Physiol"},{"key":"e_1_3_4_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/30.9.1195"},{"key":"e_1_3_4_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2020.112979"},{"key":"e_1_3_4_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ntt.2012.12.003"},{"key":"e_1_3_4_59_1","volume-title":"Wechsler adult intelligence scale: WAIS-IV; technical and interpretive manual","author":"Wechsler D.","year":"2008","unstructured":"Wechsler D. (2008). Wechsler adult intelligence scale: WAIS-IV; technical and interpretive manual. Pearson."},{"key":"e_1_3_4_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70014-6"},{"key":"e_1_3_4_61_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb09716.x"}],"container-title":["Human Factors: The Journal of the Human Factors and Ergonomics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00187208221086407","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00187208221086407","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00187208221086407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:53:16Z","timestamp":1777449196000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00187208221086407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,31]]},"references-count":60,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1177\/00187208221086407"],"URL":"https:\/\/doi.org\/10.1177\/00187208221086407","relation":{},"ISSN":["0018-7208","1547-8181"],"issn-type":[{"value":"0018-7208","type":"print"},{"value":"1547-8181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,31]]}}}