Making a difference when it’s critical

Professor Dan LongroisBoard Member, European Critical Care Foundation

Chair, National Anaesthesiologists Societies Committees, European Society of Anaesthesiology

Professor of Anaesthesia and Intensive Care, Bichat-Claude Bernard Hospital, Paris, France

What we doWe work to• improve understanding of the organisation and delivery of

critical care• raise awareness of factors that lead to unequal and

inequitable outcomes• trigger action across Europe to

overcome those barriers

Why is it important

• Window of opportunity – ECCF looks at how we canimprove treatment and care at a point in time when it canmake a crucial, or ‘critical’ difference to mortality andmorbidity

• Aim to reduce the risk of developing chronic conditions,reducing the risk of complications and readmissions andother needs for medical treatment and care in future.

Stroke

1 in 6 people worldwide will have aStroke in their lifetime

15X106 people worldwide/year

2nd leading cause of death > 60 yo

6,5X106 death/year

Leading cause of adult chronic disability

5

Baron JC, Cerebrovasc Dis 1999

Every minute

1.9 millions neurons 14 billions synapses Loss 1,8 day of good health

Saver, Stroke 2006-2014

TIME IS BRAIN !!!

6

TIME IS HEART !!!

The relative risk of 1 year mortality increasesby 7.5% for each 30 minute delay.

De Luca G, et al. Circulation. 2004;109:1223-1225.

Y=2.86 (± 1.45) + 0.0045X1 + 0.000043X2

P<.001

Roughly 1% every 3 minutes

Reperfusion Therapies Differ in Countries

9286 81 81

75 75 72 70 66 64 5949 45 45

35 33 30 30 28 24 23 19 199 8 5

10 7 2 12

53

15

8 1031

1515

40

3528

2635

30

55

2544

3341

2945

714 12 17 13

20 2515

26 26

10

36 40

15

3039 44

3542

21

52

3748 50

6350

0%10%20%30%40%50%60%70%80%90%

100%

CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO

P-PCI Thrombolysis No reperfusion

P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction inEurope: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492

www.esahq.org

A standard “Cardiac Arrest Call” number forall hospitals in Europe - 2222

• Outside hospitals in Europe there is a singlestandard emergency telephone number (112)

• Inside hospitals in Europe there is NO singlestandard emergency telephone number

www.esahq.org

Cardiac Arrest Call - current situation

• Over 105 different numbers are currently used forcardiac arrest calls in European Hospitals

• 74 hospitals used 41 different numbers in Denmark• Only about half the staff can remember the number to

call in their hospital. 50.5% in Danish study did notknow the correct number

Limited knowledge of the crash call number among hospitalstaff—A call for standardisation B. Løfgren et al Resuscitation2010 , Vol. 81, Issue 2, S28

www.esahq.org

Cardiac Arrest Call - consequences

• Not instinctively knowing the number causes delays toresuscitation teams arriving.

• Miscommunication involving the crash numberoccurred in almost 1 in 10 incidents (4/30, 13%)

• 78 staff admitted to learning the new cardiac arrestnumber from an emergency situation, therefore atleast 78 calls were delayedErrors in the management of cardiac arrests: An observational study ofpatient safety incidents in England. Resuscitation, Volume 85, Issue 12,December 2014, Pages 1759-1763 Sukhmeet S. Agnieszka M. Ignatowicz,Liam J. Donaldson

www.esahq.org

Cardiac Arrest Call and professional mobility

• The situation is made worse by healthcare staff movingaround hospitals in their own country and increasinglythroughout the whole of Europe

• In Spain in 2007 one in five nurses entering the nursingworkforce was foreign-trained or foreign-national, thisreached one in three in Italy in 2008

• 35% of doctors in UK and Ireland are foreign-trained,with the UK (42%) and Belgium (25%) experiencing thehighest inflows of foreign health professionals

Wismar M, Maier C, Glinos I et al. 2011b. Health professional mobility and healthsystems: Evidence from 17 European countries. Brussels: World Health Organization

Critically ill children

• Some 250,000 children across Europe face critical illness orinjury each year

• Most crucial of all, are the first 1,000 days of life• Wide variations across Europe in a number of areas

– Provision of services– Training and education– Standards of care– Perioperative complications– Pre-hospital emergency transport and retrieval systems– Parental involvement– Data – quantity, quality, comparability

Please join us!

Together we can make adifference when it’s critical