By Aarti Sarwal (left) and Soojin Park (right)
NCS 15th Annual Meeting theme was “It Takes a Village.” We saw the theme coming in action as it literally took a village to pull through 12 workshops at the beautiful Waikoloa Beach Resort. Preconference workshops are an important part of our members’ learning experience and require a year-long preparation of multiple teams coming together. Workshops receive immense positive feedback due to their hands-on nature and ability to receive up-close learning experience from experts about practical management issues. The 2017 conference was no different. The pre-conference workshops were again a success, with over 230 people participating. Facilitators were applauded for excellent teaching and knowledge skills, and hands-on sessions were reported to be extremely helpful in the feedback received from attendees. What follows is a brief synopsis to make our members aware of the learning opportunities available through these sessions. Please make sure to mark your calendars for this year’s Annual Meeting, Sept. 25-28 in Boca Raton, Florida.
David Hwang directed “Prognostication, Communication and Shared Decision Making: Palliative Care in ICU.” He was joined by a unique group faculty from a wide range of backgrounds. The group covered palliative care needs in severe acute brain injury, pitfalls in neuro-ICU prognostication, discussing prognosis with surrogates and shared decision making in the neuro-ICU. This workshop provided a live session with a “patient’s family” that was deemed invaluable in the feedback provided by the attendees. There were both didactic and interactive sessions focused on incorporating principles of palliative care and shared decision making into neurocritical care focusing on proper timing and triggers for palliative care consultation, common pitfalls when formulating and discussing prognosis for patients, and the use of formal decision aids. While this workshop is rotating off this year, look for this topic to be covered in the conference symposiums and in future years’ workshops.
Eric Rosenthal and Brad Kolls led two workshops on critical care EEG to cover basic and advanced interpretation of EEG in the neuro-ICU. Eric was joined by teaching faculty who covered Normal and Interictal EEG, Quantitative Basis of EEG Trend Monitoring, Ictal-Interictal Continuum and Ictal Patterns in Seizures and Status Epilepticus. This ICU EEG workshop taught fundamentals through didactic sessions and hands-on experience on normal, ictal, interictal, status epilepticus and artifactual EEG patterns. The faculty taught the American College of Neurophysiology Society Critical Care EEG Terminology and quantitative EEG trends to screen for seizures and ischemia. Participants then placed this knowledge into action, rotating through workshop stations to get hands-on experience reviewing case studies. Experts went over practical implementation of quantitative EEG monitors, prognostication using EEG, new standards for continuous monitoring of delayed cerebral ischemia in subarachnoid hemorrhage, and emerging applications of ICU EEG. They expanded the scope of learning to quantitative EEG methods, depth EEG recording, cortical spreading depolarization, and management of complex ICU cases including refractory status epilepticus. Attendees got a hands-on opportunity to explore ICU EEG devices and quantitative EEG systems and ask questions of the faculty who use these systems on a daily basis. This workshop was supported by Corticare, Moberg ICU Solutions Nihon Koden and Persyst Inc. This year, the critical care EEG workshops will merge under the directorship of Eric Rosenthal.
The Transcranial Doppler offering was incorporated into the workshops last year, and was expanded to offer hands-on skills sessions in addition to two full days of coursework in preparation for board certification. This workshop was expertly directed by Andrei Alexandrov. The didactic portion provided a review of applied ultrasound physics principles, cerebral and systemic hemodynamics as used in transcranial ultrasound assessment in critical care. The faculty helped attendees navigate through challenges of setting up a neurosonology program in the neuroICU, reviewed complete TCD protocols for SAH and stroke, and discussed the evidence supporting TCD monitoring for various clinical indications. There were interactive case presentations of TCDs in the ICU. The four-part session was designed so that participants could take them separately or sequentially; taking all four half-day sessions provided credits required for the ASN Neurosonology certification. This workshop was supported by Rimed and Compumedics DWL, Andrei Alexandrov will be bringing this workshop back this year with hopes of strengthening the educational opportunities for neurosonology education for our members.
Critical care ultrasound has become a required skill in the modern ICU. An industrious group of faculty led by director Aarti Sarwal came from a wide range of backgrounds helped attendees get exposure to learning point of care ultrasound (POCUS) as part of the Critical Care Ultrasound workshops. This daylong workshop taught skills using ultrasound in the clinical evaluation and management of a critical care patient. High-yield didactics and faculty supervised hands-on scanning stations with live models trained attendees to perform POCUS independently. Attendees learned the finer points of ultrasound knobology, point of care echocardiography, lung ultrasound, abdominal exam using the FAST protocol, inferior vena cava measurements, optic nerve sheath sonography, and review of resuscitation and evaluation algorithms for shock, respiratory distress and volume assessment. The afternoon workshop built on the basic ultrasonography skills to learn clinical goal directed scanning with review of pathology. This workshop was supported by Fujifilm Sonosite Inc., which provided machines for skill stations. This workshop will return this year under the directorship of Jose Diaz-Gomez.
Neeraj Badjatia led a workshop to teach Advanced Hemodynamics. This workshop focused on the use of hemodynamic physiology and therapy to provide optimal outcomes in TBI/Stroke/ SAH patients with acute lung injury/ARDS and covered pulse contour analysis with continuous cardiac output monitoring using PiCCO and FloTrac, Non-Invasive Advanced Hemodynamic Monitoring (NICOM). The emphasis was on cerebral perfusion optimization, pharmacology and fluids in neurocritical care. The workshop also covered hemodynamic therapy of the brain dead organ donor to increase organ yield in these physiologically complex patients. The “physiologic optimization program” was used to review real case interactive simulation sessions in enhancing the understanding of hemodynamics in neurocritical patients. The attendees found the presentation and group sessions very helpful. This workshop was supported by Cheetah Medical, Edwards LifeSciences and Getinge. This year’s workshop, under the continued directorship of Neeraj Badjatia, will bring more of this hand on experience to give an opportunity to our members in becoming experts in resuscitation.
There are practical challenges in the acquisition, integration and interpretation of multimodal monitoring data. Soojin Park led the faculty team in the Applied Neuromonitoring workshop to teach the attendees on how to overcome the technical hurdles to the effective use of multimodal monitoring data comprising of cerebral hemodynamics and EEG in multimodality monitoring with emphasis on data exploration, and high resolution data acquisition. This workshop provided a stepwise approach to the practical implementation of managing and visualizing the data from a multimodal neuromonitored patient, established through real cases. There were facilitated computer skills sessions, to introduce ICM+ software, CNS reader and R studio. The attendees applauded this as a very well prepared session as the required software and example data was provided as a download ahead of the workshop on as a USB drive at the start of the conference. This inaugural offering benefited from the generous support of many industry partners, including Ornim Medical, Compumedics DWL (TCD), Delica/Multigon (TCD), Moberg ICU Solutions, Raumedic (PTO), Integra Lifesciences (ICP), Sophysa (ICP), Nonin Medical (NIRS), and Hemedex (Bowman Perfusion Monitor). This interesting workshop will return this year under the continued directorship of Soojin Park.
An NP student attending the Advance Practice Providers workshop directed by Susan Yeager commended the tremendous amount of practical knowledge learned in this workshop. The workshop was notable for the faculty’s passion for the field of neurocritical care and their clinical expertise. The program is designed to stretch APPs clinically and professionally helping them walk away from a mental workout with new knowledge and skills that can be directly applied to their clinical practice. This year will bring back this workshop (under the direction of Lori Madden) geared toward any advanced practice provider (e.g., nurse practitioner, clinical nurse specialist or physician assistant) who is interested in taking their practice to the next level.
Course director Ines Koerner put together a Ventilation Management and Bronchoscopy workshop. This was a combined workshop focusing on different aspects of mechanical ventilation and hands-on teaching of bronchoscopy. The didactics on ventilation management used the audience response system to foster participation, and generated lots of discussion. A flipped classroom model was utilized for teaching bronchoscopy, with active learners having reviewed the didactic material (videos and online simulator) before the meeting. The workshop time was spent in facilitated hands-on experience. There was a broad range of experience levels, and the faculty expertly endeavored to offer an experience to suit everybody. The workshop was made possible through the generous support of 3D Systems, Halyard Health and Storz. This workshop will return this year under the continued directorship of Ines Koerner, with a change in focus to basic airway and bronchoscopy to meet popular demand.
An always popular and up-to-date offering, the pharmacotherapy workshop did not disappoint. Director Jason Makii conducted the Neurocritical Care Pharmacotherapy workshop. This course covered the hottest topics in neurocritical care pharmacotherapy. Expert pharmacists discussed therapeutic controversies, challenging patient populations and innovative practices in a casebased learning environment. This workshop will return this year under the continued directorship of Jason Makii.
Intracranial Monitoring is a perennial favorite and was directed this year by Josh Meadow. This workshop provided the opportunity for attendees to learn to drill and insert various intracranial monitors with facilitator guidance. There was didactic teaching on indications for monitors, best anatomical approaches to guide insertion and tunneling, troubleshooting procedures and removal of intracranial monitoring devices. Attendees also received teaching on data interpretation for brain tissue oxygen monitors, cerebral blood flow monitoring and cerebral microdialysis. The workshop was generously supported by Hemedex (Bowman Perfusion Monitor), Integra Lifesciences, MDialysis and Raumedic. It will return this year under the directorship of Amedeo Merena.
The Essential Skills of Running a Neuro-ICU workshop led by director Kristine O’ Phelan taught attendees all the skills needed to run a successful neuro-ICU. Faculty with a track record of setting up successful units across the country shared their perspectives on budgets, staffing, models, collaboration, negotiation and conflict resolution. Many attendees applauded the ample access to the presenters and the informal discussion that allowed them to share or interact with each other and learn. While this workshop is rotating off this year, look for this topic to be covered in the conference symposiums and in future years’ workshops.
This year, the theme of the Annual Meeting is “Without Borders,” with a focus on multidisciplinary groups and international participation, and the conference will be held in Boca Raton, Florida. Our pharmacotherapy and advanced practice providers workshops are expanding, and we are introducing several new offerings. There will be a workshop geared toward “Building a Quality Improvement Program in the NICU” directed by Debra E. Roberts and Casey Maureen Olm-Shipman. To amplify the partnership with the international COSBID group, whose conference will precede the NCS annual meeting, we are offering, for the first time, a hands-on sessions entitled “Clinical Monitoring of Spreading Depolarization,” led by Jed Hartings. David Greer will lead a timely workshop on “Brain Death Determination,” delving into the nuances of evaluating patients for determination of death by neurological criteria. An innovative new offering in medicine and law is a workshop entitled “You Are Named in a Medical Malpractice Suit: Now What?” directed by James Szalados.
We were sad to say goodbye to the remarkable Molly Moran from the NCS executive office, who was instrumental in facilitating the workshops. She has moved on to Northwestern to pursue a graduate degree. We are excited to introduce Jordan Winn, who has deftly taken over the role of education senior associate and has been expertly supporting workshops in development for the upcoming meeting. Preparations are already in full swing, so mark your calendars for these opportunities. See you in Boca Raton!#NCSRoundup #AnnualMeeting
#AartiSarwal #SoojinPark #June2018