Using critical care physicians to deliver anesthesia and boost surgical caseload in austere environments: the Critical Care General Anesthesia Syllabus (CC GAS)
Quincy K. Tran,
Natalie M. Mark,
Lia I. Losonczy,
Michael T. McCurdy,
James H. Lantry, III,
Marc E. Augustin,
Lovely N. Colas,
Richard Skupski,
Arthur S. Toth,
Bhavesh M. Patel,
Donald F. Zimmer,
Rebecca Tracy,
Mark Walsh
Affiliations
Quincy K. Tran
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program of Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA; Corresponding author.
Natalie M. Mark
Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
Lia I. Losonczy
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Program of Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA; Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA; Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; St. Luc Hospital, Port-au-Prince, Haiti; Memorial Hospital Trauma Center, South Bend, IN, USA; Department of Critical Care, Mayo Clinic Arizona, Phoenix, AZ, USA; Department of Emergency Medicine, The George Washington University Medical Center, Washington, DC, USA
Michael T. McCurdy
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
James H. Lantry, III
Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
Marc E. Augustin
St. Luc Hospital, Port-au-Prince, Haiti
Lovely N. Colas
St. Luc Hospital, Port-au-Prince, Haiti
Richard Skupski
Memorial Hospital Trauma Center, South Bend, IN, USA
Arthur S. Toth
Memorial Hospital Trauma Center, South Bend, IN, USA
Bhavesh M. Patel
Department of Critical Care, Mayo Clinic Arizona, Phoenix, AZ, USA
Donald F. Zimmer
Memorial Hospital Trauma Center, South Bend, IN, USA
Rebecca Tracy
Indiana University School of Medicine, South Bend Campus, South Bend, IN, USA
Mark Walsh
Memorial Hospital Trauma Center, South Bend, IN, USA
Background: Despite an often severe lack of surgeons and surgical equipment, the rate-limiting step in surgical care for the nearly five billion people living in resource-limited areas is frequently the absence of safe anesthesia. During disaster relief and surgical missions, critical care physicians (CCPs), who are already competent in complex airway and ventilator management, can help address the need for skilled anesthetists in these settings. Methods: We provided a descriptive analysis that CCPs were trained to provide safe general anesthesia, monitored anesthesia care (MAC), and spinal anesthesia using a specifically designed and simple syllabus. Results: Six CCPs provided anesthesia under the supervision of a board-certified anesthesiologist for 58 (32%) cases of a total of 183 surgical cases performed by a surgical mission team at St. Luc Hospital in Port-au-Prince, Haiti in 2013, 2017, and 2018. There were no reported complications. Conclusions: Given CCPs’ competencies in complex airway and ventilator management, a CCP, with minimal training from a simple syllabus, may be able to act as an anesthesiologist-extender and safely administer anesthesia in the austere environment, increasing the number of surgical cases that can be performed. Further studies are necessary to confirm our observation.
