ASCCA: Bridging the Link Between the O.R. and the I.C.U.

he American Society of Critical Care Anesthesiologists (ASCCA) is a subspecialty organization within ASA. ASCCA is the only professional association exclusively devoted to critical care medicine as practiced by anesthesiologists. The mission of ASCCA is to preserve and expand the pivotal role of critical care medicine as practiced by intensivists in critical care units within the scope of practice of anesthesiology and to provide educational opportunities for nonintensivists seeking to improve the perioperative care of their patients. These goals are accomplished through education and advocacy. Any anesthesiologist with an interest in the care of the critically ill patient is welcome to join.

Membership: With the renewed focus on patient outcomes from hospital administrators, payers and the government, coupled with an ever-greater load of critically ill patients in the operating room (O.R.), the ASCCA membership is nearing an all-time high! Both intensivists and nonintensivists see the value of ASCCA and the Society’s offerings.

Annual Meeting: Our 2006 Annual Meeting in Chicago last October (co-chaired by Louis Brusco, Jr., M.D., and Michael F. O’Connor, M.D.) had record-breaking attendance and focused on many patient care issues related to both the O.R. and the intensive care unit (ICU). The emphasis on “bridging the link” was extremely well received. Other highlights of the meeting included presentation of the Lifetime Achievement Award to Douglas B. Coursin, M.D., and a debate about inflammation between Clifford S. Deutschman, M.D., and William E. Hurford, M.D. This year’s meeting is still being planned, but it is likely to continue to shift toward discussion of controversies. Under the able direction of Avery Tung, M.D., and Dr. O’Connor, the meeting will be held on Friday, October 12, in San Francisco. Plan now to attend! Our Committee on Education works closely with the ASA Scientific Content Subcommittee on Critical Care to provide a broad spectrum of interesting, important and practical topics.

Resident Outreach: As part of a coordinated strategy to grow anesthesiology-based critical care, ASCCA hosted 38 residents from 33 training programs at last year’s Annual Meeting. Each resident attendee was paired with a faculty host who was available to guide them through the program, introduce them to other members of ASCCA and mentor them regarding potential careers in critical care medicine. Although only time will tell us if this program was a success, we are planning to expand and improve the mentor/resident program for next year’s Annual Meeting.

Advocacy: ASCCA is set to assume a two-year cycle as the “lead organization” of the Critical Care Workgroup (CCWG) under the direction of ASCCA President-Elect Todd Dorman, M.D. CCWG is a consortium of six specialty societies* with a direct interest in critical care medicine that addresses the Centers for Medicare & Medicaid Services on Medicare’s policies regarding payment for critical care services. In addition ASCCA has worked closely with the ASA Committee on Economics and our Specialty Society Relative Value Update Committee representatives to advance our common concerns.

Organ Donation After Cardiac Death (DCD): ASCCA, in partnership with the ASA committees on Transplant Anesthesia and Critical Care Medicine, is drafting a “Model Department Policy” on DCD. This project grew out of a request from the ASA Committee on Ethics and is another example of bridging the link between the O.R. and the ICU.

Research: As hospitals transform into large ICUs with O.R.s, the overlap between anesthesiology and critical care medicine continues to grow. Many anesthesiologists use total intravenous anesthesia techniques in the O.R., but most of the studies on these agents are done in the ICU. A current study on the microcirculatory effects of sedation¹ utilizing midazolam (with and without sufentanil) demonstrated altered vasomotor responses. This makes us question the use of these agents in hypotensive patients. The drive to develop innovative alternatives to the pulmonary artery catheter continues with a new study of Pulse Contour Analysis, suggesting it might be useful as an alternative to the pulmonary artery catheter.² Yet another area of ICU research that has O.R. implications involves transesophageal echocardiography-automated border detection³ and response to fluid challenges.

Pay for Performance: ASCCA, in conjunction with the ASA Committee on Critical Care Medicine, has made significant contributions to two of the ASA Pay-for-Performance and Anesthesiology Quality Incentive Measures (“Prevention of Cathether-Related Bloodstream Infections” and “Prevention of Ventilator Associated Pneumonia”) www.ASAhq.org/Washington/qualityincentivesdoc.pdf. ASCCA will continue to contribute to new measures as they are developed, keeping the concerns of anesthesiologists at the forefront of this movement.

References:
1. Microcirculatory alterations induced by sedation in intensive care patients. Effects of midazolam alone and in association with sufentanil. Crit Care. 2006; 10(6):R176.
2. Pulmonary artery catheter versus pulse contour analysis: A prospective epidemiological study. Crit Care. 2006;10(6):R174.
3. Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transesophageal echocardiographic automated border detection in mechanically ventilated patients. Crit Care. 2006; 10(6):R171.

Gerald A. Maccioli, M.D., F.C.C.M., is Director of Critical Care Medicine, Critical Health Systems of North Carolina, Raleigh Practice Center, Raleigh, North Carolina. He is ASA Director for North Carolina and Chair of the Committee on Critical Care Medicine.

Michael F. O’Connor, M.D., is an Associate Professor and Section Head of Critical Care, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.