Anaesthesia: solutions for an NHS in crisis – RCoA

RCoA – may 2024

Executive summary
■ NHS waiting lists are at crisis levels. Anaesthetists are key to addressing this, as most operations cannot take place without an anaesthetist and there is clear evidence that the UK needs more of them.
■ The UK has a shortage of 1,900 anaesthetists (14%). We estimate that this prevents 1.4 million
operations and procedures taking place each year.
■ The NHS currently lacks a plan for training enough doctors in specialties such as anaesthesia, but such a plan is urgently needed.
■ Measures must also be taken to boost retention, including better rest and refreshment facilities.
■ Anaesthetists play a leading role in initiatives to boost NHS efficiency, such as turning waiting lists into preparation lists, which can reduce surgical complications and cancellations and reduce length of hospital stay.
■ Start-up costs to these initiatives are a barrier. We recommend a £100 million ‘NHS efficiencies transformation fund’ to overcome initial financial obstacles

Further information – Anaesthesia: solutions for an NHS in crisis

Anaesthesia consent for children and young people living with obesity – SOBA Guideline

SOBA – 2024

Anaesthesia consent for children and young people living with obesity

British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

Intensive Care Med (2024) 50:493–501

An implantable left ventricular assist device (LVAD) is indicated as a bridge to transplantation or recovery in the United
Kingdom (UK). The mechanism of action of the LVAD results in a unique state of haemodynamic stability with diminished arterial pulsatility. The clinical assessment of an LVAD recipient can be challenging because non-invasive blood
pressure, pulse and oxygen saturation measurements may be hard to obtain. As a result of this unusual situation and
complex interplay between the device and the native circulation, resuscitation of LVAD recipients requires bespoke
guidelines. Through collaboration with key UK stakeholders, we assessed the current evidence base and developed
guidelines for the recognition of clinical deterioration, inadequate circulation and time-critical interventions. Such
guidelines, intended for use in transplant centres, are designed to be deployed by those providing immediate care of
LVAD patients under conditions of precipitous clinical deterioration. In summary, the Joint British Societies and Transplant Centres LVAD Working Group present the UK guideline on management of emergencies in implantable LVAD
recipients for use in advanced heart failure centres. These recommendations have been made with a UK resuscitation
focus but are widely applicable to professionals regularly managing patients with implantable LVADs

Further information – British societies guideline on the management of emergencies in implantable left ventricular assist device recipients in transplant centres

Validation of the MIRACLE2 Score for Prognostication After Out-of-hospital Cardiac Arrest

 Interv Cardiol. 2023 Nov 29;18:e29

Out-of-hospital cardiac arrest (OHCA) is associated with very poor clinical outcomes. An optimal pathway of care is yet to be defined, but prognostication is likely to assist in the challenging decision-making required for treatment of this high-risk patient cohort. The MIRACLE₂ score provides a simple method of neuro-prognostication but as yet it has not been externally validated. The aim of this study was therefore to retrospectively apply the score to a cohort of OHCA patients to assess the predictive ability and accuracy in the identification of neurological outcome.

Read the article – Validation of the MIRACLE2 Score for Prognostication After Out-of-hospital Cardiac Arrest

StR Survey 2023 – Summary Report of the StR-led survey on ICM training

Faculty of Intensive Care Medicine – 2023

Summary of key issues and actions from the 2023 survey of Doctors in Training (DiTs) in ICM conducted by the Faculty of Intensive Care Medicine (FICM) Specialist Registrar (StR) Sub-Committee.

Read the report – FICM StR Survey 2023 Report

Best practice for management of Dual/Triple/Single CCT ICM trainees

The Faculty of Intensive Care Medicine – Published 14/03/2024

Our recent ICM StR Survey highlighted concerns regarding the variability in the experiences of Intensivists in Training (IiTs) from medical and emergency medicine backgrounds compared to those from an anaesthetic background. The RCoA and FICM Training Committees felt it was important to outline the general principles on how these doctors should be supported by anaesthetic and critical care departments. There is complexity in providing such bespoke training and both training committees would like to thank their entire network of trainers for their hard work and dedication in supporting doctors from such diverse backgrounds. 

This guidance has been cascaded to all Anaesthetic and ICM Heads of School, Training Programme Directors, Regional Advisors, Deputy Regional Advisors, College Tutors, Faculty Tutors, Clinical Directors and Clinical Leads. 

Best Practice for the Management of Intensivists in Training

Emergency airway management: an EUSEM statement with regard to the guidelines of the Society of Critical Care Medicine

European Journal of Emergency Medicine 31(2):p 83-85, April 2024. 

Emergency airway management (EAM) is a complex task. Manual skills needed for EAM are learned through practice and need to be maintained with regular training.

Patients and their conditions are usually completely unknown, the administration of drugs for the procedure with all the potential side effects must be induced promptly, although conditions are not optimal.

Recently, the Society of Critical Care Medicine (SCCM) published practice guidelines for EAM of critically ill patients [¹]. In this viewpoint, we aim to briefly and critically examine the recommendations and identify further necessary action points. These are the key points that we also convey to emergency physicians and paramedics in the EAM Course of the European Society of Emergency Medicine (EUSEM).

Further information – Emergency airway management: an EUSEM statement with regard to the guidelines of the Society of Critical Care Medicine

Background – Society of critical care medicine clinical practice guidelines for rapid sequence intubation in the critically Ill adult patient.

ESPEN practical short micronutrient guideline

Clin Nut 2024;43:825-857

Micronutrients, a generic term for trace elements and vitamins, are essential components of nutrition in health and disease. For the general population, international recommendations are available in the form of recommended dietary allowances (RDA), or more recently, as DRI (Dietary Reference Intakes). However, there are yet no standardized procedures for the determination of requirements or recommendations for intake for patients with acute and chronic diseases. To assist clinicians, the recent ESPEN guideline [

[1]] provides practical recommendations for the assessment of the micronutrient (MN) status in adult patients and information about basic or increased amounts, covering the fields of enteral and parenteral nutrition.

The original document is very long since it includes extensive biochemistry physiology and advice on each of the MN. Therefore, the present abbreviated guideline is a summary focusing on the recommendations and clinical practice applications. The iteration of the guideline is of even higher importance after the publication by the World Health Assembly (WHA) of their resolution to accelerate efforts regarding micronutrient provision with safe supplementation.

Further information – ESPEN practical short micronutrient guideline

2024 edition of the Guidelines for the Provision of Anaesthetic Services – RCOA

The Royal College of Anaesthetists – Published: 31/01/2023

This edition includes fully revised versions of the guidelines on Inpatient Pain, ENT, Oral Maxillofacial and Dental surgery and Vascular procedures. A new chapter on Regional anaesthesia is also currently being developed and will be published later this year.

First published in 1994, GPAS supports anaesthetists with responsibilities for service delivery and healthcare managers to design and deliver high quality anaesthetic services. All GPAS chapters are developed using a rigorous, evidence-based process and the recommendations form the basis of the standards used by the Anaesthesia Clinical Services Accreditation (ACSA) scheme.

Further information – 2024 edition of the Guidelines for the Provision of Anaesthetic Services

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

World Journal of Emergency Surgery volume 19, Article number: 4 (2024)

The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies.

This consensus provides practical recommendations to support a clinician’s decision making in the management of tSCI polytrauma patients.

Further information – Early management of adult traumatic spinal cord injury in patients with polytrauma: