International Symposium on Intensive Care and Emergency Medicine (ISICEM)
The most famous ICU conference (other than SMACC) has been on this week.
Li Huey Tan, an intensivist currently working at The Alfred hospital in Melbourne was there feeding us live reports as a mini-blog to give those of us who couldn’t make it a bit of a taster…
Click “Read more” to hear Li’s third report.
March 20 at ISICEM
Should we be performing ” emergency coronary angiography for all?” in OHCA? Guiseppe Biondi-Zoccai thinks we should. The best part is, he’s a cardiologist! Aufderheide in Lancet 2011 showed the incidence of angiography in OHCA is only 33%. Yet, 70% of OHCA have significant coronary lesions ( Spauldinger 1997). As a cardiologist, he feels that the absence of new LBBB or ST changes should not exclude diagnostic angiography. The downside to not sending these patients to the Cath lab is that the longer you wait, the chances of survival reduces if the cardiac arrest is related to a coronary lesion. There is also this entity of Persistent Precipitating Pathology in the Post Cardiac arrest Syndrome patient. Jerry Nolan discusses the utility of pro calcitonin as a marker for predicting severity after cardiac arrest. Turns out, just because we get ROSC, does not mean everything is fine and dandy, this brings us back to the whole concept of disruption of microcirculation and reperfusion injury. Therapeutic hypothermia may work at this level in the CA patient to prevent endothelial dysfunction. How about using some supplements such as coenzyme Q 10 in these patients? We await jerry’s RCT in this area. Might be a good time to pop to the local Priceline for a stash of these pills before Pfizer gets wind of this.. Another interesting discussion was that 2/3 of OHCA patients who are cooled develop pneumonia. There’s speculation that prophylactic antibiotics may be the next thing to investigate. Watch this space.
Who said oxygen is good for you? Evert de Jonge discusses the effects of hyperoxia in CA patients which leads to vasoconstriction and a paradoxical reduction in cardiac output despite an increase in tissue p02. Unfortunately, this is restricted to retrospective studies at present.
Robotic intensivists? We all like to stay in the scratcher (bed in irish slang) don’t we? So one of these RP VITA will set your department back about $200k. Is that the cost of employing an intensivist? The general consensus is that we are looking at the likelihood of nighttime intensivists like they have in most continental European units and a handful of Australian units. Vespa from UCLA as well as Gernot Marx anticipate a shortage of doctors in future which will not be able to meet the increasing demand in resources. There isn’t much evidence to support the benefit of nighttime intensivists. This is partly because we don’t need the bosses at night all the time. But rather when we need them, it’s usually for short periods of time and intermittently. Paul Vespa also acknowledged that critical care during the night time is not the same as during the day. He found that care bundles were less likely to be implemented on night shift or ‘forgotten’. The robot ward round allows care bundle compliance and continuation of day time goals during night shift. The robots could be useful during out of ICU resuscitation as a team leader.
I finished off my last day of the conference with rehabilitation in ICU. Tim Walsh emphasized the need for continuity of specialist care post ICU discharge as well as community discharge to support Post ICU Syndrome in our patients. There is a huge cost burden in the community and recommended more research in this area. Given the multi faceted approach to studying the various outcomes, this is going to be a time consuming and costly exercise. Rehab ICU clinics seem to be a norm in the UK these days. I wonder if the Australians will take this on? If we are indeed spending all this money during their acute illness in ICU, surely it matters just as much after patients are sent home to ensure their function is restored?
I would have loved to stay another 2 days at the meeting, but duty calls. Overall, a fantastic critical care meeting with engaging topics and discussions. Like this blog? Please give some feedback.
Li Huey Tan