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A twelve-year-old girl struggling to breath was set to be the next casualty in Denmark's 1952 polio epidemic. When all other attempts failed, America-trained anesthesiologist Bjorn Ibsen stepped in and proposed treating her akin to his patients during surgery with intubation and ventilation. The girl survived, and Ibsen subsequently organized 1500 volunteer staff to ventilate, slashing mortality rates from 87% to less than 15% with bulbar poliomyelitis.1 Later that next year, Ibsen converted a surgical recovery room into a unit where any patient could receive critical care, essentially founding the world's first modern intensive care unit.2 Ibsen's ingenuity was applying operating room medicine and technology to patients in need of intensive treatment.
Since the practice of critical care has grown, the intensive care unit has started to look quite similar to the operating room in pharmacology, monitoring, intubation, and more. Similarly, the operating room is oftentimes colloquially described as a "one patient ICU" where anesthesiologists take anyone from a complex trauma patient to an elective inguinal hernia patient and transform them into a critical care patient for the duration of a procedure.
The ACGME requires first-year anesthesiology residents to spend at least one month in critical care and emergency medicine during their first year.3 This should not be a surprise given the skills needed in anesthesiology, but is important to recognize as these requirements do not extend to other specialties. Anesthesia continues to have an integral role in emergency and critical care in Europe as well. In fact, oftentimes an anesthesiologist in Europe may follow a patient from the pre-hospital setting through their ICU stay.4
The role of anesthesiologists in critical care continues to evolve, and there is no better example than the growing subspecialty of cardiothoracic critical care. These anesthesiologists' command of managing cardiogenic shock and ECMO have made them experts. Their role has become more prominent during the pandemic where COVID-19 has made their knowledge and skillset critically important.5 Even before COVID-19, anesthesiologists were leading the charge with the development of mobile ECMO teams.6 As seen in this subspecialty, critical care continues to be furthered by anesthesia-trained intensivists.
It cannot be ignored that anesthesia critical care does not have the same place in the United States as it does globally. Suffice to say, intensive care units generally do not have compensation parity with the operating room.7 Over 70% of these intensivists are in academic medical centers, and critical care physicians have a higher rate of burnout.8 Even still, no provider is better suited for critical care than the anesthesiologist.
My hope is that medical students, residents, and trainees of all levels can understand that anesthesiology and critical care are two sides of the same coin. The fields are deeply rooted together in past, present, and future.
For more information on the field, check out the ASA guideline on the principles of critical care medicine and consider joining the Society of Critical Care Anesthesiologists.
Works Citedposted October 2021
