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Paving the Path to the Future: Curing Coma

By Currents Editor posted 04-04-2019 10:56

  

By Shraddha Mainali, MD, and Paul M. Vespa, MD, FCCM, FAAN, FANA, FNCS
Special thanks to Jose Javier Provencio MD, FCCM, FAAN, FNCS; Susanne Muehlschlegel MD, MPH, FNCS, FCCM; and Daiwai Olson, RN, PhD, CCRN, FNCS

It is an exciting time to be in neurocritical care. There has been tremendous growth of this field with important progress in education, patient quality and advocacy, and training in the last decade. The progress in research has been remarkable, with the recent publication of important clinical trials and observational studies. However, the research efforts for our specialty appear to be fragmented across multiple areas of interest, and in some cases, led by our colleagues from other, related disciplines. 

In 2016, the leaders of the Neurocritical Care Research Central (NCRC) and the Neurocritical Care Research Network (NCRN) identified important gaps in our research portfolio and envisioned an approach to begin to work constructively on these gaps. This effort led to the Blue Ocean/Fifth NCRN Conference in Boca Raton, Florida, on Sept. 25, 2018. A brief overview of this meeting has been published in the December 2018 issue of Currents magazine. A formal report of this conference will be published in Neurocritical Care later in spring 2019.

The Blue Ocean Conference was an interactive, six-month-long process involving about 100 NCS members from all over the world to debate and discuss these gaps. The focus of the meeting was to create a novel approach that would distinguish our field and create a paradigm shift in the manner in which we approach these gaps. The following conclusions were drawn from this meeting by the research leadership:

  1. We have not proposed nor do we own the scientific agenda for our field.
  2. We have not identified the top scientific unmet needs for our field.
  3. We have not identified a mission-critical topic that would advance the care of our patients and the science of our field.
  4. We have not created an infrastructure to facilitate collaborative research to address the unmet needs and/or mission-critical topic.
  5. We have not created a method to mentor and develop the careers of would-be researchers from our multidisciplinary membership.

The conference was very successful and resulted in a wide range of discussions about our mission-critical topic, and has provided an honest assessment of our pathway forward. The mission-critical topic that has been embraced after much deliberation is “Curing Coma.” The goal is to develop an understanding of the mechanisms that underlie coma in critically ill patients and discover preventive and novel therapeutic measures. In general, “Curing Coma” is thought to be in the unique skillset of the field of neurocritical care, yet broad enough to include the collaborative work of all different types of practitioners and researchers working in various areas of neurocritical care. A 10- to 20-year mission is estimated to address this important topic and a plan is in progress to build the necessary infrastructure to achieve this goal.

In addition to this critical mission, the NCRC and its various subcommittees will be working on three near-term themes proposed by the Blue Ocean group:

  1. Create a research mentorship program for inexperienced researchers.
  2. Create short-term research projects to address important unanswered questions stemming from the uncertainties raised by the NCS Guidelines Committee.
  3. Create a research accelerator process that allows rapid development of research projects and collaboratives.

In summary, the NCRC is actively working on implementing the recommendations from the Blue Ocean Conference and is working with the NCS Board of Directors to create a longitudinal plan that will benefit the society, its members and our patients.

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