RESUMO
Background Extracorporeal Membrane Oxygenation (ECMO) provides a heart-lung bypass for patients with life-threatening cardiorespiratory failure. It is a classic low-volume, a high-risk procedure that requires specialized training to develop and maintain competence. Therefore, our ability to train efficiently and effectively is essential. The purpose of this study is to determine if specific participant training or experience leads to better performance in emergency ECMO scenarios during high-fidelity simulation training. Methods Fifty-one physicians, nurses, and respiratory/medical technicians participated in a study comparing an animal model vs. simulation-based ECMO education. All completed a multiple-choice questionnaire about prior ECMO experience and other demographics, as well as a four-hour pre-lab didactic session. They completed individual ECMO scenarios with both modalities during two sessions, and task completion times (minutes) and scores (percentage) were measured using a validated ECMO skills assessment tool. The scores of the 19 participants who completed the simulation-based scenarios during their first session were further analyzed in the context of their self-reported ECMO experience, and participants were divided into a novice group and an experienced group. Statistical testing included the Mann-Whitney U test (times) and Fisher's exact test (scores). Results Data from the 19 participants who completed the simulation-based ECMO training on the first session showed no statistically significant differences in the task completion time or scores among those in the novice group vs. the experienced group in the years of ECMO experience category (28 vs. 34 minutes; p=0.66 and 61% vs. 62%; p=0.54), a number of cannulations category (30 vs. 25 minutes; p=0.11 and 59% vs. 62%; p=0.82) or the number of ECMO patients cared for category (28 vs. 34 minutes; p=0.30 and 57% vs. 62%; p=0.54). Findings were similar for both the lecture-based training and simulation-based training categories, respectively (33 vs. 28 minutes; p=0.71 and 62% vs. 60%; p=0.91 and 34 vs. 28 minutes; p=0.74 and 63% vs. 58%; p=0.12). Conclusion Among this small subset of participants, we observed no statistically significant differences in performance based on participant experience during simulation-based ECMO scenarios. The didactic/review sessions preceding the training may have contributed to an effective form of training for participants with no prior ECMO experience. Due to the small sample size of this study, further studies are needed to better elucidate what factors lead to better performance in emergency ECMO scenarios.
RESUMO
Pharmaceuticals and personal care products (PPCPs) are contaminants of emerging concern that are increasing in use and have demonstrated negative effects on aquatic organisms. There is a growing body of literature reporting the effects of PPCPs on freshwater organisms, but studies on the effects of PPCPs to marine and estuarine organisms are limited. Among effect studies, the vast majority examines subcellular or cellular effects, with far fewer studies examining organismal- and community-level effects. We reviewed the current published literature on marine and estuarine algae, invertebrates, fish, and mammals exposed to PPCPs, in order to expand upon current reviews. This paper builds on previous reviews of PPCP contamination in marine environments, filling prior literature gaps and adding consideration of ecosystem function and level of knowledge across marine habitat types. Finally, we reviewed and compiled data gaps suggested by current researchers and reviewers and propose a multi-level model to expand the focus of current PPCP research beyond laboratory studies. This model includes examination of direct ecological effects including food web and disease dynamics, biodiversity, community composition, and other ecosystem-level indicators of contaminant-driven change.
