Regional meetings are an important way to advance the care of neurocritically ill patients globally, and transitioning from hybrid meetings to a fully in-person meeting has come with several benefits. First, it has brought increased regional attention to the role of workshops in introducing and advancing care. This culminated in our ‘blue ocean’ project, which materialized on a large scale with three full-day Brain Death Determination workshops thanks to the collaboration of multiple societies. Second, it has led to increased regional interest in ENLS, the NCS flagship course, especially when it was bundled with data-driven gap analyses exploring the adaptability of ENLS in resource limited settings (1-3). Third, it has facilitated the development of the second edition of Neurointensive Care: A Clinical Guide to Patient Safety | SpringerLink, edited by Katja E. Wartenberg, Khalid Shukri, Tamer Abdelhak. Now, as we near the 5^th Regional Neurocritical Care meeting in the Middle East and Africa next month, it is important to reflect on how we got here.

The Fourth Regional Meeting

As part of the neurosciences sessions, the scientific program included ENLS (May 12), a full-day neurocritical care track (May 13), and three full-day Brain Death Determinations workshops that continued post-conference (May 14-16). The neurocritical care track focused on: (1) management of the neurocritical care patient, with topics ranging from delirium and dysphagia to hemodynamic and ICP targets; (2) updates on neurovascular disorders and status epilepticus; (3) pro and con debates on anesthesia for neuro-intervention and anticoagulation for cerebral venous sinus thrombosis; and (4) the anticipated updates from the 2023 American Academy of Neurology Brain Death guidelines. The half-day Neurocritical Care Nursing track (May 14) discussed neurocritical care nursing focused issues and ways to become a nurse leader in the field. Accepted abstracts submitted to the Regional Meeting were subsequently published in Neurocritical Care.

Overall, this conference was attended by 1633 delegates. Of the 238 speakers, 40% were international, 34% local, and 26% regional, representing a total of 34 countries. There were 8 total workshops including ENLS and Brain Death Determination.

Brain Death Determination Workshops

As a result of the collaboration between the United Arab Emirates (UAE) Ministry of Health and Prevention (MOHaP), the ECCC, and NCS, three full-day Brain Death Determination workshops were conducted on May 14, 15, and 16, 2023, with 20 faculty speakers involved. The planning of these workshops took place over 18 months. Overall, 328 participants registered and attended the workshops over 3 days (262 physicians and 66 nurses). MOHaP sponsored the workshops for all registrants, while NCS waived fees for nurses as they attended as observers. All participants had full access to the NCS online Brain Death Toolkit. Of the 262 physician registrants, 39 (15%) were from Group B countries and 2 from Group A countries.

Certification was offered to registrants who were eligible to declare death by neurological criteria in their county of practice. To become certified, registrants had to complete the NCS toolkit and exam. Of the 262 physician registrants, 107 (41%) completed all requirements, while 33 (13%) started but did not complete the process (database accessed February 2024). The remaining registrants are still encouraged to complete the certification process.

Although not eligible for certification, 34 (52%) of 66 nurse observers electively completed the above requirements and another 14 (21%) started the process. This strongly supports the multi-disciplinary nature of determination of death by neurological criteria.

Acknowledgements

I feel honored to list the societies and individuals who worked as a team to transform 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 like to highlight the newly formed partnerships with DGNI and the Indian Society of Neurocritical Care. Secondly, I would like to sincerely thank the voluntary efforts of all the speakers and moderators.

Regional Meeting and Nursing tracks/ENLS/Brain Death Determination workshops speakers and moderators: Tamer Abdelhak, Ayoub Abualrobe, Yasser Abulhasan, Ali Al Obaidli, Haifaa Algithami, Mustafa Al-Mousawi, Fayez Al-Shamsi, Maha Aljuaid, Omar Ayoub, Mary Kay Bader, Sara Chafee, Jamil Dibu, Michael Diringer, Hussam Elkambergy, Jennifier Frontera, Maria Gomez, David Greer, Ayman Ibrahim, Saef Izzy, Kalpana Krishnareddy, Sarah Livesay, Edward Manno, Majid Mokhtari, Laura Nedolast, Marco Pallavidino, Lucie Pelunkova, Wolf-Dirk Niesen, Hemanshu Prabhakar, Farid Salih, Haamid Siddique, Michel Torbey, Panayotis Varelas, Katja Wartenberg, and Khalil Yousef.

Additionally, I would like to acknowledge (1) Katja Wartenberg and Khalil Yousef for co-directing the ENLS course, (2) Sarah Livesay and Khalil Yousef for co-leading the Neurocritical Care Nursing track, and (3) Panayotis Varelas and David Greer for co-directing the Brain Death Determination workshops. Sincere thanks go to Hussain Al Rahma (conference chairman) and team, and Katja Wartenberg for co-organizing the 4^th Regional Meeting with me.

Global Partnership Milestones

Since 2011, the NCC-MENA chapter of IPACCMS has been one of the foremost global partners of NCS, and NCS leadership has participated in the open annual NCC-MENA chapter meeting. Over the years, the neurocritical care track of the ECCC has continued to grow. ENLS was first offered in 2016, then in 2018, 2019 (in-person), 2021 (hybrid), 2022 (in-person), and 2023 (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, and in June 2021, the hybrid format 2^nd Regional Meeting, 3^rd Regional Meeting and 4^th Regional Meetings were conducted in conjunction with the 15^th, 17^th, 18^th, and 19^th editions of the ECCC, respectively. In 2023, the first NCS Brain Death Determination workshops with certification were conducted in the UAE.

Our Mission

Overall, critical care representation of neurosciences in our region is strong, vital, and expanding. And, to answer the title question justifying in-person Regional Meetings: the effort, diligent planning, and follow-up of discussions during an in-person Regional Meeting all result in advancement of neurocritical care and spread the mission and vision of NCS globally.

Fifth Regional Meeting – Wood Anniversary

For now, save the date for May 10-12, 2024, when we will look forward to welcoming you all in Dubai for the 5^th Neurocritical Care Regional Meeting of the Middle East/Africa, part of the 2024 Emirates Critical Care Conference. The meeting will include one full-day neurocritical care track, one full-day ENLS training, three half-day updated Brain Death Determination workshops (in line with the 2023 American Academy of Neurology guidelines), one half-day TCD workshop, and abstract presentations.

As we near our 5-year wood anniversary celebration, we hope to see you soon in Dubai!