Anesthesiologist as Resuscitation Consultant
As medical practice matures in the era of immediate availability of information, the role of the anesthesiologist as the resuscitation consultant becomes increasingly apparent. Anesthesiologists are subject matter experts in clinical pharmacology as well as bedside physiology. Furthermore, they are skilled in the application of these concepts to challenging clinical situations with expertise in a variety of life-saving procedures.
The anesthesiologist can contribute to resuscitation in the trauma bay, the operating room, or in the interventional radiology suite as well as the intensive care unit. Outside of the United States, anesthesiologists also attend to the sickest patients in the prehospital environment. Anesthesiologists have pioneered many life-saving advances in critical care in decades past and are uniquely qualified to contribute to the future of resuscitation. One could say that the future of anesthesiology is resuscitation, and the future of resuscitation is anesthesiology.
Dr Howard and colleagues offer a thorough review of cognitive aids in resuscitation and advanced life support. As they point out, the varied etiologies of cardiac arrest/critical incidents in the anesthetic environment emphasize the need for such aids in perioperative resuscitation. Their discussion of the psychological and human factors processing involved in the development and use of cognitive aids is fascinating. Training the resuscitation consultant of the 21st century will certainly involve use of cognitive aids such as they have presented.
Our pediatric cardiology colleagues led by Dr Rossano have contributed their expertise to the discussion of extracorporeal membrane oxygenation in resuscitation. Their wonderfully referenced review of extracorporeal membrane oxygenation for in-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest defines the current state-of-the-art. The discussion of predictors of outcome and logistical considerations add a welcome clinical perspective to the article.
The concept of prehospital resuscitation is reviewed in the article by Tobin and Lockey. The European experience with forward critical care in both the civilian and military systems is discussed in the context of potential advantages as well as limitations.
Young and colleagues have provided a thorough review of pediatric resuscitation. It is an informative, well-referenced, and concise summary of the role of the pediatric anesthesiologist as resuscitation consultant to the critically ill child.
A thoughtful review of some of the major ethical issues surrounding resuscitation has been provided in an engaging case-based format by Dr Souter and Dr Slade. Informed consent, medical futility, and consent for research are all important considerations in the resuscitation of the critically ill/injured patient. The authors use “real world” examples to highlight concepts in the ethics of resuscitation and emergency care. Prospective consideration of these sometimes emotionally charged topics can mitigate conflict if and when it arises. This manuscript provides a template for these sorts of discussions and adds to the understanding of commonly encountered ethical issues in resuscitation.
A concise and well-written review of the major topics in fluid resuscitation and blood product management is presented by Dudaryk and colleagues. Their discussion of the 4 stages of resuscitation adds a practical summary to the evolving concept of damage control resuscitation (and when to stop it). The discussion of the physiological underpinnings of rational fluid management touches on the importance of microcirculation in shock states. Shock truly is a flow issue, rather than a pressure issue, and their article helps to highlight that important distinction.
Dr Jones and colleagues present an informative review of the current state-of-the-art of our understanding of the bleeding trauma patient.