neurovascular issues (ICH and ischemic stroke)—60 patients,
among others. As the national neurovascular referral center, we
receive patients with aneurysmal subarachnoid hemorrhage,
arteriovenous malformations, and fistulas from across the country.
Patients are admitted under the care of the intensivist team
with consultation to neurology and neurosurgery services. An
intensivist and a group of ICU residents lead the rounding team.
The nurse-to-patient ratio is 1:3. There are no physician assistants
or advanced practice nurses in Ecuador. The ICU management
protocols are based on the application of currently available and
accepted international guidelines, bearing in mind our limitations.
These include the lack of proper equipment such as restricted
capabilities for multimodality neuromonitoring and endovascular
therapies, and no continuous EEG technology. In addition, there
are limitations in the availability of parenteral medications,
temperature management devices, and plasma exchange machines.
Figure 1
32%
29%
20%
19%
Neurocritical Care Emergency Other areas Operating Room
Education and Training
Education and training programs in general critical care have
been available for the last 15 years. However, there is currently no
formal neurocritical care training program in the country. Our ICU
has become actively involved in local and international research
projects, such as the BEST TRIP trial.
We have instituted international collaborations with the goal
of improving patient care, promoting education and training
of health care professionals, and establishing research projects.
Edgar Samaniego, MD, and Santiago Ortega, MD, from Iowa
State University (ISU) join the local neurointerventional
team every three months and treat complex vascular cases.
We are currently setting up a formal agreement between the
Universidad San Francisco de Quito (USFQ)/HEEE and ISU to
develop a neurointerventional training program. In addition,
we have been working on a curriculum for a neurocritical
care fellowship program and guidelines for the development
of a neurocritical care unit under the leadership of Jose I.
Suarez, MD, from The Johns Hopkins University, and Nelson
Maldonado, MD, from USFQ.
The International Neurologic and Neurocritical Care Annual
Conference takes place in Quito, and after three successful
gatherings, we are very proud and happy to report that for the
2017 meeting we have partnered with NCS to turn it into the
official venue for the South American Regional Chapter of NCS.
The conference is scheduled during the third week of November,
and specialists from all over South America and the United States
will attend and share their clinical experiences and potential
research collaborations. Simultaneous translation is available to
enhance the exchange of ideas among attendees. We also have
organized a parallel Neurocritical Care Research Summit at the
Galapagos archipelago to evaluate needs and recommendations
for research in this field in Ecuador and throughout the region.
Finally, we are maturing research projects such as the High
Altitude Neurophysiology and Applied Knowledge (HANAK)
program, which is a combined effort between U.S. academic
centers, USFQ, and YACHAY led by Jose I. Suarez and
Nelson J. Maldonado with the overall goal of understanding
neurophysiologic differences between high altitude and sea
level dwellers.