ASCCA: Carrying Critical Care Into the Future

Anesthesiologists historically have played a key role in establishing critical care as an important clinical subspecialty requiring a specialized fund of knowledge and clinical skills. Over the past few years, however, the role anesthesiologists have played in critical care has diminished significantly. As articulated in my article on page 6 of this issue, recent developments in the health care marketplace provide an opportunity and the imperative for expansion of our role in the intensive care unit (ICU). The American Society of Critical Care Anesthesiologists (ASCCA) believes it is essential that anesthesiologists play a key role as the prominence of intensive care medicine in the American health system increases. ASCCA’s mission is to preserve and expand the pivotal role of critical care medicine, as practiced by intensivists in intensive care units, within the scope of practice of anesthesiology. This will be accomplished through education, advocacy and community.

Several recent developments indicate that ASA leadership is acutely aware of the importance of critical care medicine (CCM) and wishes to facilitate the goals of ASCCA. First, at the ASA 2003 Annual Meeting, the House of Delegates passed an important resolution that endorsed the role of anesthesiologist-intensivists in the ICU and authorized the formation of a task force to evaluate how to extend critical care activities within the specialty. The charge to this task force is to present a realistic vision of what anesthesiologist-intensivists believe needs to be done to refine and redefine ASA’s role with regard to the practice of CCM.

The task force is co-chaired by Gerald A. Maccioli, M.D., chair of the ASA Committee on Critical Care Medicine and Trauma Medicine, and myself as current ASCCA President. In forming this task force, ASA President Roger W. Litwiller, M.D., appointed a prominent group of anesthesiologists who also are intensivists and who have shown a commitment to the education of anesthesiologist-intensivists, leaders from academic anesthesiology with a background in critical care and a representative from cardiac anesthesiology, neuroanesthesiology and pediatric anesthesiology, subspecialties where critical care medicine is prominent.

Members of the task force include James G. Ramsay, M.D., a cardiac anesthesiologist-intensivist from Emory University; Todd Dorman, M.D., Director of the CCM Fellowship Program at Johns Hopkins University; William E. Hurford, M.D., Professor and Chair of Anesthesiology at the University of Cincinnati; the former director of the CCM Fellowship at the Massachusetts General Hospital, Alex S. Evers, M.D., Professor and Chair of Anesthesiology, Washington University, St. Louis, Missouri; W. Andrew Kofke, M.D., a neuroanesthesiologist-intensivist from the University of Pennsylvania; Jayant K. Deshpande, M.D., a pediatric anesthesiologist-intensivist from Vanderbilt University; C. William Hanson III, M.D., Director of Critical Care Medicine at the University of Pennsylvania; and ASCCA Immediate Past President Neal H. Cohen, M.D., Professor of Anesthesiology/Perioperative Medicine and Vice-Dean of Faculty at the University of California-San Francisco. The task force has begun to formulate its proposals. Dr. Maccioli and I are scheduled to present our recommendations to the ASA Board of Directors in August 2004. It is our hope that a resolution that defines how to implement the recommendations can be formulated for consideration by the House of Delegates in October at the ASA 2004 Annual Meeting.

A second important opportunity to broaden the footprint of anesthesiologist-intensivists has been created with plans to change the format of the ASA Annual Meeting and increase the participation of subspecialty groups. In an effort to revitalize the symposium, the program committee has elected to add subspecialty tracks, with one of the first being a critical care track on Saturday and Sunday of the Annual Meeting. The program is being formulated by a committee chaired by Dr. Cohen. Members include Dr. Dorman, Dr. Maccioli, Andrew Gettinger, M.D., from Dartmouth University and Michael F. O’Connor, M.D. from the University of Chicago. Dr. Cohen has outlined the details of the process and the program on page 15 of this NEWSLETTER.

Finally, I am pleased and excited to announce that the recipient for the first annual ASCCA/FAER/Abbott Laboratories Physician Scientist Award has been identified. The winner is Guido Musch, M.D., from Massachusetts General Hospital. His proposal is titled “Regional Effects of Alveolar Recruiting Strategies on Gas Exchange and Cellular Inflammation in Acute Lung Injury.” The award is sponsored by ASCCA, administered by the Foundation for Anesthesia Education and Research (FAER) and financed by a generous unrestricted grant from Abbott Laboratories. Dr. Musch will receive salary support for two years to allow protected time to conduct his research. We hope the funding of this award will continue on an annual basis as ASCCA, FAER and Abbott all agree that the need for support of research education in critical care is of paramount importance. Special thanks to Jeffrey S. Balser, M.D., Ph.D., Vanderbilt University, Robert N. Sladen, M.B., Columbia Presbyterian Medical Center, and Yvonne Harter of Abbott for their stellar work in making this award possible.

In finishing I once again urge each ASA member to consider the importance of critical care medicine to you as an individual and anesthesiologists as a group. Make intensive care medicine part of your group’s practice. Negotiate contracts that contain reimbursement for ICU coverage (individuals within ASCCA can assist you). Educate your hospital administrators, your professional colleagues, your legislators and your patients. Anesthesiology is the practice of medicine and, by extension, the practice of intensive care medicine. Help to nurture this viable, growing specialty!

Clifford S. Deutschman, M.D., is Professor of Anesthesia and Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.