The Neurocritical Care Society has positioned itself as an international society, and despite facing many challenges, it has been successful in expanding its global outreach. This has been evident in the Middle East and Africa with five regional meetings thus far, each of which featured robust neuroscience content for physicians, nurses, and pharmacists. This year’s meeting featured new workshops aimed at enhancing providers’ skill sets, with more workshops planned in the future. Further, NCS’s ambitious ‘blue ocean’ project has strived to standardize the determination of death by neurological criteria across the region while bringing new opportunities for research.

The Fifth Regional Meeting in Dubai, May 10-12, 2024

Overall, this conference was attended by 1928 delegates. Of the 305 speakers, 47% were international, 30% local, and 23% regional, representing an impressive 52 countries. The neuroscience program included 10 total workshops and courses including ENLS training (May 10), a full-day neurocritical care track (May 11), a transcranial Doppler (TCD) workshop (May 12), and three half-day Brain Death Determination workshops that continued post-conference (May 12-13).

The neurocritical care track focused on: (1) practice updates, with topics including blood pressure management in SAH, neurosurgery for ICH, extended time windows for AIS, and improving outcomes after TBI; (2) updates on neuro-prognostication guidelines, with an emphasis on SAH, ICH, TBI, and cardiac arrest; (3) pro and con debates on thrombolysis in patients on direct anticoagulants and ICP monitoring in hemispheric infarcts; and (4) monitoring in the neurocritical care unit, with topics on pediatric patients, non-invasive ICP monitoring, personalized perfusion pressure, and glucose control. This was followed by a full-day Neurocritical Care Nursing track on May 12, which was well-attended and focused on relevant nursing issues including the neurological exam, level of consciousness, language, the NIH Stroke Scale, ICP, disparities in AIS, and stroke systems of care. Accepted abstracts submitted to the Regional Meeting were subsequently published in Neurocritical Care.

The Second Series of Brain Death Determination Workshops

The United Arab Emirates (UAE) Ministry of Health and Prevention (MOHaP), the Emirates Critical Care Conference (ECCC), and NCS continued their collaboration for a second year, this time specifically aiming to standardize the process of brain death diagnosis in the UAE. Three half-day Brain Death Determination workshops were conducted on May 12-13, 2024, with 10 faculty speakers and new updates according to the 2023 Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline: Report of the AAN Guidelines Subcommittee, AAP, CNS, SCCM. These workshops offered hands-on education that demonstrated the specifics of determining death by neurological criteria and communicating with families and other healthcare providers.

Overall, 358 healthcare workers registered for the Brain Death Determination Course, of whom 248 (69%) attended the workshops (including 152 physicians, 62 nurses, and 34 senior medical students). MOHaP sponsored course access and workshop attendance for all registrants, while NCS waived course access fees for nurses who attended as observers. Of the physicians who attended, 2 were from Group B countries and 1 from a Group A country. Certification was offered to registrants who were eligible to declare death by neurological criteria in their country of practice and who successfully passed the online exam offered by the NCS. If not already completed, all registrants are still encouraged to complete the online exam.

As this was the second year conducting a large-scale educational workshop in a country that recently adopted death by neurological criteria in a legal decree, it was important to address several research questions, including the immediate and long-term benefits of this multi-disciplinary educational tool at the national level. As such, a research team led by Drs. Haamid Siddique, Lori Shutter, Panayotis Varelas, and Matthew Kirschen have been tasked with tackling these questions, with results to follow.

Transcranial Doppler (TCD) Workshop

There is increasing appreciation of the role of TCD as a non-invasive tool in assessing cerebral hemodynamics in acute cerebrovascular diseases and neurocritical care. The ECCC reintroduced the TCD workshop in an updated format as a pilot to gauge interest amongst local clinicians. Dr. Aarti Sarwal directed this workshop with a team of 5 neurocritical and neurosurgical faculty and an engaging group of 17 participants who were practicing neurocritical care clinicians from the region. The workshop, which was endorsed by the American Society of Neuroimaging and the European Society of Neurosonology and Cerebral Hemodynamics, offered participants the opportunity to learn to perform image acquisition using various techniques and to interpret intracranial hemodynamic waveforms using a structured approach. Participants showed significant interest in pursuing further training to master this skill set and receive certification from the above endorsing societies according to their respective requirements. Registrants interested in pursuing formal TCD certification will get further training opportunities to complete the requirements at the 2025 meeting in Kuwait and Dubai (detailed below).  

Acknowledgements

I feel honored to name the societies and individuals who worked as a team to turn this meeting into a reality. Firstly, the partnership between the International Pan Arab Critical Care Medicine Society (IPACCMS) and NCS is strong and continues to grow, and I would also like to applaud the partnerships with the Indian Society of Neurocritical Care and the Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin (DGNI). Additionally, integrating the neurocritical care nursing track into the World Federation of Critical Care Nurses (WFCCN) program added a new venue for nurses invested in neurocritical care to collaborate.

I would like to highlight the voluntary efforts of all the speakers. Regional Meeting and Nursing tracks/ENLS/TCD/Brain Death Determination workshops speakers: Tamer Abdelhak, Ayoub Abualrobe, Yasser B. Abulhasan, Abdullah Al Jadidi, Ali Al Obaidli, Zeyad Al Rais, Hosam Al-Jehani, Maha Aljuaid, Sana Alkhawaja, Omar Ayoub, Mary Kay Bader, Ahmad Bayrlee, Sara Chaffee, Jamil Dibu, Michael Diringer, Salia Farrokh, Matthew Kirschen, Kalpana Krishnareddy, Sarah Livesay, Nihmeh Mahmoud, Ilko Maier, Majid Mokhtari, Laura Nedolast, Wolf-Dirk Niesen, Marco Pallavidino, Lucie Pelunkova, Hemanshu Prabhakar, Rennan Ribeiro, Aarti Sawal, Haamid Siddique, Lori Shutter, Panayotis Varelas, Paul Vespa, Katja Wartenberg, Thomas Westermaier, Khalil Yousef, and Patricia Zrelak.

Additionally, I would like to acknowledge (1) Katja Wartenberg for directing the ENLS course, (2) Khalil Yousef and Lucie Pelunkova for co-leading the neurocritical care nursing track, which was integrated into the WFCCN Congress and the Neurocritical Care Regional Meeting, (3) Aarti Sawal for directing the TCD workshop, and (4) Lori Shutter and Panayotis Varelas for co-directing the Brain Death Determination workshops. A well-deserved thank you goes to Hussain Al Rahma (conference chairman) and team, and Katja Wartenberg for co-organizing the 5^th Regional Meeting with me.

Global Partnership Milestones

Since 2011, the NCC-MENA chapter of IPACCMS has been one of NCS’s foremost global partners, and NCS leadership has participated in the open annual NCC-MENA chapter meeting. Over the years, the neurocritical care track of the ECCC has also continued to grow. ENLS was first offered in 2016, then in 2018, 2019 (in-person), 2021 (hybrid), and 2022-2024 (in-person). In October 2018, NCS confirmed the first Mid-East/Africa member to represent the region on its Board of Directors. In April 2019, the 1^st NCC Middle East/Africa Regional Meeting was conducted in-person in Dubai, followed by the hybrid format 2^nd and 3^rd Regional Meetings during the pandemic, and the in-person 4^th and 5^th Regional Meetings over the past two years—these were conducted in conjunction with the 15^th, 17^th, 18^th, 19^th and 20^th editions of the ECCC, respectively. In 2023 and 2024, the first and second NCS Brain Death Determination workshops with certification were conducted in the UAE. The 2024 meeting was designated as our Wood Anniversary!

Our Mission

Overall, neuroscience representation within critical care in our region is strong and continues to expand. The diligent planning and voluntary efforts of everyone who contributed over the years has resulted in the regional advancement of neurocritical care, spreading the global mission and vision of NCS.

Sixth Regional Meeting and Endorsed Meeting

For now, save the date for February 1-3, 2025 (with pre-conference workshops on January 30-31), when we will look forward to welcoming you all in Kuwait for the 6^th Neurocritical Care Regional Meeting of the Middle East/Africa, part of the 20^th International Pan Arab Critical Care Medicine Society Conference. The meeting will include multiple neurocritical care sessions, a full-day ENLS training, one-day Traumatic Brain Injury workshop, two-day TCD workshop, and abstract presentations. To present your work in Kuwait, please feel free to submit your abstract by December 1, 2024 for blinded review.

Also, save the date for May 10-12, 2025, when we will look forward to welcoming you all in Dubai for the annual Emirates Critical Care Conference.

We hope to see you soon in Kuwait and Dubai!