Khalid A. Alsherbini [1], Andrei V. Alexandrov [2], Jamil Dibu [3], Omar Ayoub [4], Ahmed Yassin [5], Muath R Alqurashi [6], Yasser Abulhasan [7]

Introduction

Back in April 2020, we published our first article in Currents discussing the history of neurocritical care (NCC) in Jordan as one of the leading countries in the Middle East to recognize brain death and perform organ transplantation [1]. We also discussed ongoing challenges and the obvious need to establish training and education pathways to advance the field of NCC even further. This is a huge task that requires robust collaborations between the local government and various health sectors to overcome the different logistical and financial challenges. In addition, establishing programs for public awareness and education is vital for the success of the field.

Given the global reach of the Neurocritical Care Society (NCS), we collaborated with our regional partner to start building a chapter for NCC in Jordan with providers who are currently practicing there, some of whom trained in the United States, as well as providers practicing in the United States with Jordanian roots. Our goals were to provide systems and plans for a structured NCC education program, starting with introducing Emergency Neurological Life Support (ENLS) and established NCS guidelines. In collaboration with the Jordanian Medical Council, the ultimate goal is to establish a pathway for NCC training and possibly certification in Jordan in the near future.

Our first NCC symposium in Jordan took place in September 2023, with a successful collaboration with the Jordanian Neurological Society (JNS) during their annual international meeting held at the Dead Sea on September 27-29, 2023. This meeting is usually heavily tailored to general neurology, although a full day is dedicated to epilepsy since Jordan has a well-established international epilepsy chapter as part of the International League Against Epilepsy (ILAE). This was the first time a half-day symposium was dedicated to NCC, during which eight presentations on major NCC and stroke topics were given by experts from the USA and Jordan’s neighboring countries, including the United Arab Emirates (UAE) and the Kingdom of Saudi Arabia (KSA) where NCC is especially well-developed for the region.

The NCC symposium sparked a great deal of interest among attendees given the quality of the talks and the importance and relevance of the topics to their practice. Speakers emphasized the need for building multidisciplinary teams, guidelines, and training especially for nursing and health care providers, as well as the need to obtain certain technologies and medications which are not available in this part of the world. During the NCC symposium, Dr. Jamil Dibu presented a valuable review of updates in intracerebral hemorrhage (ICH) management, focusing on BP control, anticoagulation reversal, and new surgical trials in ICH. Dr. Andrei Alexandrov discussed stroke updates and recent trials of thrombolysis and thrombectomy. Dr. Omar Ayoub went over the diagnosis and management of neuromuscular emergencies in the ICU, while Dr. Khalid Alsherbini discussed updates in status epilepticus management. We also had interactive sessions discussing transcranial Doppler (TCD) basics and cases for neurologists, ICU consults for neurologists, practical challenges of brain death diagnosis and apnea testing, and interesting EEG cases from the neuro-ICU.

Given the strong and positive feedback from the audience, we were enthusiastically received by JNS conference organizers who were eager for a collaboration between JNS and NCS that would lead to full training certification courses for ENLS, Brain Death, TCD, and ICU EEGs. They also welcomed the idea of dedicating a full day of the JNS annual meeting that was tailored to NCC topics, with a plan to expand the target audience and attendees of next year’s meeting beyond neurologists to also include neurosurgeons and trainees, critical care physicians, emergency physicians, nurses, and pharmacists. The long-term goal is to plant the seed to eventually achieve the goal of starting a comprehensive advanced NCC training program in the country.

Our speakers shared their positive experiences about participation in this effort. Dr. Dibu (Cleveland Clinic Abu Dhabi) reflected upon the quality of the talks, which were all tailored to the practices and resources available in Jordan and attracted a great deal of attention from the audience, with many attendees expressing interest in learning more about NCC. Dr. Alexandrov (University of Arizona) also shared his positive feedback regarding ongoing work about establishing a stroke center in one of Jordan’s cities, with discussions on their treatment rates and challenges including establishing stroke protocols. Dr. Omar Ayoub (KSA) shared the positive impact of this event on the development of the field, along with the importance of collaboration between Jordan and other countries like the KSA and UAE in addressing the health care needs of the region. All our speakers highlighted the amazing hospitality they received from JNS and the people of Jordan, the amazing historical sites including the site of the Baptism of Jesus, and the beautiful nature in the country including the incredible experience of the Dead Sea and the towering rock formations and slender valleys of Wadi Rum.

The Dead Sea and the towering rock formations and slender valleys of Wadi Rum.

The team enjoying the magic of the Dead Sea, where you can float effortlessly because of its high salt and mineral concentration

The team visited “Wadi Rum” after the conference, spending a night exploring the desert where the movie “The Martian” was filmed

In conclusion, this symposium was hopefully just the beginning of a successful collaboration and effort to cultivate the field of NCC in Jordan, especially with the strong interest and support from the JNS and local experts. We are hoping for a collaboration with NCS at the international level, both for planning larger-scale events and interactions with health care providers in university-based, military, health ministry, and private sector hospitals, and educating and training the next generation to provide comprehensive neurocritical care in the country.