Medical emergencies: when music helps (Part 1/3)

Are you a rock fan? According to a study, if "Highway to Hell" riffs at high volume in the operating theatre, there's a good prognosis!

Music on the ward

About the author: Prof. Nicolas Peschanski works as an Emergency Medicine consultant at the Centre Hospitalier Universitaire de Rennes, France. Translated from the original French version

Acute medicine and music... It has a long history but one that is rarely discussed and even less studied. The reading of a recent article allowed me to wonder about the particular relationship that we, emergency physicians, have with music. In short, it was an opportunity to analyse the place it has in our practice. But first, let's go back to this article and take a quick detour to the operating theatre.  

Imagine: you are in the operating theatre, and a surgeon bent over your body. You think that a cathedral-like silence improves the concentration of the person handling the scalpel, right?

Wrong: some people are disturbed by silence and can only concentrate in the presence of noise or background music. The proof is in the results of a recent German study1: surgeons' speed and precision increase when the riffs of AC/DC's Highway to Hell - the chosen interventional factor - are played in the operating room (Author's note: for the uninitiated, Larousse tells us that a "riff" is "a short melodic fragment of two or four bars, repeated rhythmically to accompany a melodic line")

Never enough AC/DC

According to the study authors, rock anthems such as AC/DC's Highway to Hell and TNT, played at high volume, improved the dexterity of surgical interns practising precision surgery.1 On the other hand, softer rock music - in this case the Beatles' Hey Jude and Let It Be - also improved accuracy and speed during other surgical procedures, but only when played at medium volume.

In this study, 30 surgical interns from the University of Heidelberg with no experience of laparoscopy practised four training procedures in three different musical settings. The procedures were a transfer of prosthetic materials, balloon preparation, precision anatomical cutting and suturing. While performing these procedures, the interns listened to either soft rock (The Beatles), harder rock (AC/DC) or... nothing.

Pump Up The Volume

The music was played at two volume levels, medium and high. The interns knew that there would be disturbances during these sessions, but did not know the exact nature of the disturbances. The quality of each surgical procedure was assessed at the end according to three factors: accuracy, speed of execution and compliance with associated safety criteria.

According to the findings of this article in the Langenbeck Archives of Surgery, the results speak for themselves. When listening to AC/DC at high volume, the interns reduced the time required to perform a precision incision from 139 seconds (without music) to 114 seconds, an 18% increase in performance. Furthermore, their accuracy was not compromised.

Small caveats

However, there are some confounding factors, biases and limitations. 73% of the participants admitted that AC/DC is one of their favourite music groups, and that this music is often played at high volume. This was therefore not new to these interns.

Furthermore, the students were also faster at making a 15cm suture when listening to The Beatles, but only if the songs were played at medium volume. Indeed, this positive influence disappears if the "soft" rock is played too loud, probably because the relaxation it is supposed to provide decreases with an increasing sound level. It can be assumed that each piece of music should therefore be played at a certain volume level, for which it is intended.

Another limitation raised by the authors concerns the sound level in real-life conditions. It could vary according to the volume of the operating room, the setting of the sound alarms (scopes, etc.) and the number of people present in the room.

Finally, in order to verify these results in real conditions, the musical tastes of all the personnel present should be taken into account, and not only of the surgeon, because it can be envisaged that if these songs do not appeal to the whole team, this could alter the surgeon's performance and/or the work of the other personnel present in the operating theatre (anaesthetist, operating room nurse, etc.) and therefore could slow down the procedure.

Indeed, these pieces were chosen for their "timeless popularity" but also to reflect the abandonment of classical music as the only listening experience for surgeons. Indeed, in the past, only classical music was allegedly associated with better concentration for surgeons, compared to silence (for film buffs, I refer you to Patrick Swayze's role in Roland Joffé's City of Joy).

So much for the surgeons. But one particular point in this study speaks to my emergency room heart. Music with a fast tempo (BPM> 100/min) seems to be able to improve the speed of the surgical gesture. In the context of emergency medicine, we already know that the Bee Gees' song Staying Alive provides the right tempo for cardiopulmonary resuscitation and improves the quality of chest compressions for external cardiac massage.2

But does music have other benefits in my practice as an emergency physician? We invite you to continue to Part 2 of this series.

  1. Yang C, Möttig F, Weitz J, Reissfelder C, Mees ST. Effect of Genre and amplitude of music during laparoscopic surgery. Langenbecks Arch Surg. 2022 Mar 24. doi: 10.1007/s00423-022-02490-z. Epub ahead of print.
  2. Hafner JW, Sturgell JL, Matlock DL, Bockewitz EG, Barker LT. "Stayin' alive": a novel mental metronome to maintain compression rates in simulated cardiac arrests. J Emerg Med. 2012 Nov;43(5):e373-7.