Two Neuro ICUs, One Standard of Care
Date: March 1, 2008
A stroke victim arrives in the emergency department in immediate need of the clot-busting tPA—and a bed in the neurosciences critical care unit. The NCCU at Hopkins Hospital is full, but the unit at Johns Hopkins Bayview Medical Center has a bed.
So the patient, after receiving tPA, is transported by ambulance to Bayview. The difference? Three cross-town miles versus seven stories up. Other than that, the two units are pretty much exactly the same. They have the same diagnostic and therapeutic technology, the same attendings, the same fellows and residents.
“We are one group,” stresses Romer Geocadin, director of the eight-bed Bayview NCCU. “There’s no wall between us. When we get a referral, we don’t even for a moment bat an eyelash and ponder where the patient needs to be, because everything we do on the units is identical.”
Patients on these neuro ICUs suffer with acute illnesses like subarachnoid hemorrhage, ischemic and hemorrhagic stroke, traumatic brain injury, brain infections, brain tumors, acute coma, seizures and acute respiratory failure from neurologic causes. For these critically ill patients, a multidisciplinary team, led by the attending neurointensivist working closely with specially trained neuro-ICU nurses, strives to provide the best chance of recovery.
Neurosurgeons, neurologists, interventional neuroradiologists and other specialists funnel all their ideas and plans through the neurointensivists. “We do the quarterbacking,” says Geocadin. “In neurocritical care, there’s virtually no margin for error. You can’t have various specialists second guessing one another. We can work easily with neurologists and neurosurgeons because there’s a wonderful respect between us all.”
The field of neurocritical care was brought to life at Hopkins Hospital. One of the nation’s first neuro intensive care units was established here in 1982; the field itself was conceived by Hopkins physicians Dan Hanley and Donlin Long. Several landmark papers have been published by Hopkins neurointensivists, including one showing that patients with neurological injury have a better chance of survival when admitted to a neuro ICU.
That paper was authored by Marek Mirski, who today oversees the 22-bed NCCU at Hopkins Hospital and directs the Division of Neurosciences Critical Care. Enjoying the highest level of clinical activity, academic productivity and NIH research support, the division has trained more academic neurointensivists now directing prestigious programs