NEUROTRAUMA SURGERY AND CRITICAL CARE
NEUROTRAUMA CRITICAL CARE
Critical care is an important component in the succesful management of the neurotrauma patient. Low and middle income countries regularly has deficits in subspecialized training programs for neurological critical care. One of the fellowship aims is to expose neurosurgeons to neurocritical care in austere and non austere environments, focused on neurotrauma patients. Critical care transport is also an additional part of the process of care that have been show as a weakness component in several studies in low and middle income settings.
To prepare neurotrauma subspecialists in the understanding of these critical issues is fundamental for the appropriate training in global care of neurotrauma.
Neurotrauma surgery is also a essential component of the neurotrauma management. Regularly the skills for the decision making process in complicated neurotrauma scenarios require a mixture of evidence based knowledge and surgical experience with ethical challenging options. Exposure to different levels of resources for integral neurotrauma care will allow the fellow to bring context into these complex decisions based on transformational knowledge and leadership skills developed during this learning unique environment.
Barrow Neurological Institute at Phoenix Children's Hospital have sofisticated ICU neurotrauma critical care facilities for children and adult patients. The fellow will be exposed to protocols of care and research process within these environments.
In Latin America several health centers are involved in the training process, including trauma centers from Colombia and Brazil. The main objective is to understand limitations and work within these different environments trying to optimize resources without compromising care quality.
In the United Kingdom, the Addenbrooke´s Hospital and the University of Cambridge Hospital Network will allow the Fellow to be part of a unique environment of Neurotrauma and Global Health Clinical Research Training, sharing clinical rounds at the Neuroscience Unit and participating in Lectures of the the Advanced Neuromonitoring Research Unit.
Kolias AG, Rubiano AM, Figaji A, Servadei F, Hutchinson PJ. Traumatic brain injury: global collaboration for a global challenge. Lancet Neurol. 2019 Feb;18(2):136-137
"Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the World Health Organization, the World Federation of Neurosurgical Societies and International Collaboration Initiatives like the Global Health Research in Neurotrauma Group, supported by the NIHR, have been creating a new paradigm in order to improve neurotrauma care worldwide..."
Rubiano AM, Carney N, Chesnut R, Puyana JC. Global neurotrauma research challenges and opportunities.
Nature. 2015 Nov 19;527(7578):S193-7.
"Traumatic injury to the brain or spinal cord is one of the most serious public health problems worldwide. The devastating impact of 'trauma', a term used to define the global burden of disease related to all injuries, is the leading cause of loss of human potential across the globe, especially in low- and middle-income countries. Enormous challenges must be met to significantly advance neurotrauma research around the world, specifically in underserved and austere environments. Neurotrauma research at the global level needs to be contextualized: different regions have their own needs and obstacles. Interventions that are not considered a priority in some regions could be a priority for others..."
Rubiano AM, Puyana JC, Mock CN, Bullock MR, Adelson PD. Strengthening neurotrauma care systems in low and middle income countries. Brain Injury. 2013. 27(3):262-272.
"In developing countries, there are difficulties in fully integrating the resources for care if the local and regional trauma systems are poorly structured. Factors like inadequate emergency and neurointensive care, low compensation compared with elective procedures or high medico-legal risks may result in a lack of interest from the few available neurosurgeons to be fully integrated in neurotrauma care"... "Appropriate structuring of trauma systems according to countries needs and their functionality is a key element that would facilitate the optimal use of resources for integral neurotrauma care"...