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Neurocritical Care Services in National Brain Center Hospital, Jakarta

By Currents Editor posted 09-27-2022 09:23

By Ita Muharram Sari, MD

National Brain Center Prof. Dr. Mahar Mardjono Hospital (NBC) is the main referral hospital specializing in brain and nervous systems under the Ministry of Health Republic of Indonesia. As a center of excellence, NBC gives advanced clinical practice on neurological diseases, education, and training for healthcare workers and also provides translational and comprehensive research in the neurological field. NBC is located in Jakarta and launched its first operation in July 2014 with a current capacity of 250 beds.

Advance Clinical Practice
The neurocritical care D=division of NBC consists of a neurocritical care unit (NCCU), stroke care unit (SCU), and high care unit (HCU), with a total of 30 beds. We currently have 12 beds in ICU level 3 in NCCU, with a total of 762 patients in 2021. Approximately 35% of NCCU patients undergo tumor surgery, and 25% of patients admitted with stroke. For daily care in NCCU, two nurses take care of three patients. Neurocritical services have not been widely developed in our country, and NCCU in NBC was the first neuro ICU in our country. As a referral hospital, we also treat many complicated cases in neurology. We started continuous EEG monitoring for our patient with super refractory status epilepticus and performed plasma exchanges for selected cases. Due to the limitations of device, we use non-invasive equipment to monitor some patients with high intracranial pressures.

Picture 1. Daily nursing care in NCCU

We have 18 bed ins ICU level 2 in SCU-HCU, with a total of 1,200 patients during 2021. We monitor acute stroke patients with unstable hemodynamic, patients after thrombolysis or mechanical thrombectomy, and large infarction. For daily operations, our division is under the management of neurointensive and support from other specialists. All our patients in this division receive daily multidisciplinary care from allied health professionals such as physiotherapists, dieticians, and pharmacists. We have ICU rounds, neurosurgery, vascular, and case discussions weekly.

Picture 2. Vascular round for SAH cases in SCU

Education and Training

Since early 2022, our hospital has also acted as a network center of care for stroke in Indonesia, which will manage over 500 public hospitals in all districts in Indonesia. Like in other countries, stroke has become a significant problem in Indonesia. Based on Basic Health Research, stroke prevalence has increased from 7% in 2013 become 10.9% in 2018. We have a population of more than 270 million people in 2021, and 2.5 of 1000 people in our country are at risk of stroke per year (⁓500000). But there are disparities in hyperacute stroke care between our hospital and others. Intravenous thrombolysis was very rare and limited in some big cities or private hospitals. As a network center, we provide training in hyperacute stroke care for general practitioners and nurses in ER.

Picture 3. Staff of Neurocritical Care Division in NBC

As teaching hospitals, we routinely accept neurology residents from several medical faculties for two weeks of the neurocritical rotation. We also held training for skilled nurse stroke and dietitian students for clinical study in our division. In February 2019, we had an ENLS course that participants from some cities in Indonesia attended.

Picture 4. Nurses in the NCCU

Indonesia still doesn’t have a specific neurocritical society comprising many health professionals. As neurologists, we joined a neurocritical study group in the Indonesian Neurology Association and held the first annual meeting (NAMNIC) on 16 May 2022. We have the Indonesian Neuroscience Nursing Association for neurocritical nurses, which routinely gives Basic Neurology Life Support. We still need a comprehensive approach in this field to provide better neurocritical care in this country.

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