Critical Care Summit 2015 -ECMO Milestones in Egypt
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Transcript of Critical Care Summit 2015 -ECMO Milestones in Egypt
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Professor of Critical Care MedicineCritical Care Department
Cairo University
2015
Prof. Dr. Alia Abd El-Fattah
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Male Patient got Avian flue → ARDS (at El Salam International
Hospital).
Treating physician in ICU (Assistant Professor in Critical
Care Department) gave the hospital his recommendation for
“ECMO support”.
His insurance company called Dr. Palmer who came & put
the patient on ECMO → transferred him to his center.
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Scientific day arranged by Dr. Akram
Abdelbary introducing the ECMO technology &
its applications (Guest speakers: Prof. Steve
Conrad & Prof. Allan Combes).
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Critical Care Department, Cairo University Chief of
Department was convinced to introduce ECMO as a
technique & activity.
Donations were directed to build up Center of Excellence
for the Department.
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Cairo University 1908
Medical school1928
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Kasr El Aini is the main tertiary hospital for whole EGYPT
It serves 20 million population in Cairo, inaddition to the referral of complicated cases fromcountry side.
It receives around 1 million patients per year (outpatient services, operations and admissions).
Capacity: 3,800 beds, 300 ICU beds.
Staff: 3000 staff members.
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1. Cairo University Critical Care department isthe first established and the leading alloverEgypt for Critical care specialty
2. We are dealing with innovation in the field.
3. A lot of efficient, well trained physicians inCritical Care Department (25 Professors, 30Ass. Prof, 50 Lectures, 35 Associate Lecturers,22 Residents).
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4. Experience of Critical Care staff in the field of
pulmonary and cardiac Critical Care is very strong e.g.,
primary PCI for STEMI (1994).
Primary PCI → Routine daily practice in our
department (150-200/year)
The first place to excecute primary PCI in EGYPT &
maintained the only place for years.
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Why the choice of critical care department to
be the nucleus of ECMO service in EGYPT?
Cardiogenic shock complicating acute MI → Real
challenge in Critical Care (15% of acute MI cases).
Intra-aortic balloon pump (IABP) was introduced
in Critical Care Department for the first time in Egypt
(1982).
We trained our team & our training was
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In 500 top universities worldwide
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1. Place: Cairo University Hospital – Critical Care
Department
2. Equipments':
Cardio help (2013)
Rota flu (2014)
Cardio help + ECCO2 removal (2015)
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3. Personnel:
Choice of doctors to build up ECMO team:
3 seniors (Ass. Professors)
Trained abroad under supervision of
Prof. Allan Combes (France)
Certification (Diploma)
They have to supervise & train the young staffin the department)
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4. Nursing staff: well trained in critical Care
5. Related specialties:
a. Chest physician b. Cardiac surgeon
c. Radiology facilities d. Vascular surgeon
1. Chest X-Ray
2. CT: Chest, Brain, Abdomen
3. Abdominal Sonar 4. Cannulation guided Sonar
5. Echocardiography 6. Duplex
e. Blood bank & blood products
f. Dialysis
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How to build up ECMO team (con.)
Choice of 1st case:
• H1N1 → ARDS (pt was a physician working in ICU)
• X Ray
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Choice of 1st case:
• Running the whole procedure by Egyptian team
• V-V ECMO → Cardio help
• 3 weeks on ECMO
• Full recovery and successful weaning
How to build up ECMO team (con.)
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Dedicated young physician & senior staff available
24/7.
All complications were managed by critical care
physicians (ECMO team).
Active contribution of related specialties (chest
and cardiac surgery).
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Learning curve over one year:
Management of 6 cases on cardio help then Rota
flue by the EGYPTIAN Team
Consultations: By Phone & e-mail
France (Allan Combes)
USA (Steve Conrad)
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6 cases (2 high risk)
3 survivors
Mortality = 50%
(cases were vasculitis, MOF)
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Chris Meadows, (UK)BSc MBBS MRCP FRCA PGCM FFICMConsultant in Intensive Care, Anaesthesia & ECMOCritical Care Safety, major Incident and Patient Experience LeadGuy's & St Thomas 'NHS' Foundation Trust, London
Dr Jeremy Cardingley, (UK)Consultant in Intensive Care Medicine & AnaesthesiaDirector, Adult Intensive Care UnitRoyal Brompton HospitalSydney Street, London
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• First Egyptian experience in Extracoporeal life support in Critical Care Department, Cairo University
• Presenting: Dr. Akram Abd El Bary• Under supervision: Dr. Alia Abd El Fattah• Four cases were discussed thoroughly (from our department) in the
conference
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D- Egyptian Critical Care Summit 2015
Hosting Eminent Guest speakers:
Dr.BartlettDr.Combes
Mini courses
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BAL to exclude eosinophilic lung
was done
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Thursday, February 05, 2015
37
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Selection of cases: consensus, as usual
Research
Training then certification of more younger staff
Fulfilling international criteria for participation andaffiliation to the Associations for Extra CorporealLife Support.
Egypt deserves to be the center of excellence forECMO activity in the Middle East
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First ELSO member center in
EgyptCritical care
dpt.2014
Alia Abdelfattah
AkramAbdelbary
Mohamed Khaled
Wael Sami
Ahmed Hares
Hani Tawfik
Mohamed Yousri
Dina Zaid
Ahmed Saeed
Ahmed Mostafa
Ahmed Rostom
Mahmoud Saad
Mohamed Saad
Mohamed Abuelwafa
Mohamed Aly
Ibrahim Elzoghbi
Mohamed Aly
Abdo
AmanyAbouZeid
Mohamed Sewelam
Tarek Mhsen
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