Critical Care Summit 2015 -ECMO Milestones in Egypt

Professor of Critical Care MedicineCritical Care Department

Cairo University

2015

Prof. Dr. Alia Abd El-Fattah

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.

Scientific day arranged by Dr. Akram

Abdelbary introducing the ECMO technology &

its applications (Guest speakers: Prof. Steve

Conrad & Prof. Allan Combes).

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.

Cairo University 1908

Medical school1928

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.

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).

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.

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

In 500 top universities worldwide

1. Place: Cairo University Hospital – Critical Care

Department

2. Equipments':

Cardio help (2013)

Rota flu (2014)

Cardio help + ECCO2 removal (2015)

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)

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

How to build up ECMO team (con.)

Choice of 1st case:

• H1N1 → ARDS (pt was a physician working in ICU)

• X Ray

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.)

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).

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)

6 cases (2 high risk)

3 survivors

Mortality = 50%

(cases were vasculitis, MOF)

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

• 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

D- Egyptian Critical Care Summit 2015

Hosting Eminent Guest speakers:

Dr.BartlettDr.Combes

Mini courses

BAL to exclude eosinophilic lung

was done

Thursday, February 05, 2015

37

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

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