Impact of an Advanced Cardiac Life Support Process Improvement Initiative on Leadership Role Comfort

Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED) requires optimized advanced cardiac life support (ACLS). An ACLS leader monitors compressions, orders medications, performs rhythm checks, directs defibrillation, and times events. This role was reassigned from physicians to nurses. Nurse led ACLS may allow physicians to assess ECPR inclusion criteria. There is limited research on ACLS leader role comfort for nurses. We hypothesized an ECPR initiative in the ED would improve personnel comfort in the ACLS leader role. ECPR initiative implementation included didactics and simulation training. A survey was distributed to ED residents, attending physicians, and nurses, and included six Likert-scale items on comfort with the ACLS leader role. Surveys were administered 6 months prior to and 3 months after implementation. There were 91 respondents at baseline and 100 respondents in the follow-up, resulting in a 43% and 48% response rate, respectively. We used Mann-Whitney tests to compare ordinal variables and non-parametric tests to assess the impact of initiative completion and level of experience on a cumulative score for comfort. We observed no significant changes for the six comfort items from the baseline survey regardless of respondent group. In the post-period, nurses (22.6/30) and resident physicians (23.9/30) had significantly lower mean cumulative comfort scores when compared to attending physicians (27.5/30) (p\u3c .001). Experience leading ACLS in the past 12 months was a significant predictor of cumulative comfort score for nurses in the post-period (p = .029), even when completion of ECPR requirements was controlled. While most report comfort acting in the role of ACLS leader there was no significant improvement post-initiative. These findings, combined with the significance of experience leading ACLS on comfort for nurses and resident physicians, suggest continued experiential learning and opportunities for simulation

Bacterioplankton drawdown of coral mass-spawned organic matter

Coral reef ecosystems are highly sensitive to microbial activities that result from dissolved organic matter (DOM) enrichment of their surrounding seawater. However, the response to particulate organic matter (POM) enrichment is less studied. In a microcosm experiment, we tested the response of bacterioplankton to a pulse of POM from the mass-spawning of Orbicella franksi coral off the Caribbean coast of Panama. Particulate organic carbon (POC), a proxy measurement for POM, increased by 40-fold in seawater samples collected during spawning; 68% degraded within 66 h. The elevation of multiple hydrolases presumably solubilized the spawn-derived POM into DOM. A carbon budget constructed for the 275 µM of degraded POC showed negligible change to the concentration of dissolved organic carbon (DOC), indicating that the DOM was readily utilized. Fourier transform ion cyclotron resonance mass spectrometry shows that the DOM pool became enriched with heteroatom-containing molecules, a trend that suggests microbial alteration of organic matter. Our sensitivity analysis demonstrates that bacterial carbon demand could have accounted for a large proportion of the POC degradation. Further, using bromodeoxyuridine immunocapture in combination with 454 pyrosequencing of the 16S ribosomal RNA gene, we surmise that actively growing bacterial groups were the primary degraders. We conclude that coral gametes are highly labile to bacteria and that such large capacity for bacterial degradation and alteration of organic matter has implications for coral reef health and coastal marine biogeochemistry