GSA Action Committees

GSA Site Description of Committees

Committee to Support Sepsis as Emergency

Contact: Konrad Reinhart	Konrad.Reinhart@med.uni-jena.de
Proposed Members: K. Abrams, A. Artigas, R. Daniels, J. Faulk, V. Giamarellos, K. Shurki, K. Reinhart, P. Dellinger, Y. Koh, T. Kissoon

GSA ratified and then issued a global to Call to Action to "GSA, supported a declaration that urged the medical community to "recognize sepsis as a medical emergency requiring the administration of fluids, antibiotics and other appropriate treatments of infection within one hour of suspicion of sepsis."

The objective of this committee is to identify efforts to recognize and treat sepsis as an emergency and to share protocols and materials generated with all groups. Below see information about efforts underway.

The Center of Sepsis Control and Care (CSCC) at the Jena University Hospital in partnership with the Global Sepsis Alliance and the German Sepsis Society initiated the Medical Education for Sepsis Source Control and Antibiotics MEDUSA trial.

Contact: Konrad Reinhart	Konrad.Reinhart@med.uni-jena.de
Frank Bloos	frank.bloos@med.uni-jena.de

Worldwide, approximately 40% of all patients do not receive treatment according to current recommendations and guidelines of medical societies. Furthermore, a considerable gap exists between ICU directors' perceptions and practiced adherence with evidence-based guidelines. These guidelines of the Surviving Sepsis Campaign (SSC) recommend application of intravenous broad-spectrum antibiotics within 1 hour after diagnosis of sepsis. Although some of the recommendations are controversial, several single-center studies including a study by CSCC investigators supported the hypothesis that quality-improvement efforts based on the SSC guidelines are associated with better outcome.

The primary study objective is to investigate whether a multifaceted educational program with a focus on the early adequate antimicrobial therapy in patients with severe sepsis and septic shock reduces 28 days mortality.

MEDUSA is multicenter, cluster randomized trial limited to hospitals located in Germany. On the patient level, it is an observational study. Inclusion criteria: Involvement in the care of patients with severe sepsis, willingness to participate in quality improvement. Patients: New onset of suspected severe sepsis or septic shock in one of the following settings: prehospital, emergency department, operation theatre, normal ward, intensive care unit / intermediate care unit.

So far the 40 participating hospitals from all over Germany enrolled over 700 patients

U.K Sepsis Trust and U.K Pre-hospital Sepsis Working Party

Contact: Dr. Ron Daniels

sepsisteam@googlemail.com

In partnership with the Global Sepsis Alliance, a collaboration of the U.K Sepsis Trust and the U.K Pre-hospital Sepsis Working Party are proposing a major multi-faceted project to address gaps in the delivery of seamless care to patients with sepsis.

The Pre-hospital and Emergency Care component, it is proposed, will combine process improvements in recognition, early intervention and communication through the national introduction of a pre-hospital screening tool to facilitate pre-alerting of Emergency Departments, and the evaluation by Ambulance Services in 3 major cities of pre-hospital intervention including sampling of blood cultures and administration of fluids and antibiotics.

The Hospital Ward Care component will focus on gaps in knowledge of, and ability to recognize, sepsis in ward-based medical and nursing staff through the development of remote learning objects (RLOs) permitting rapid web-based self-training in the condition and the construction of an i-Phone/ i-Pad application combining a sepsis screening tool with therapeutic guidance.

The Critical Care and Technology component aims to evaluate and develop applications of a novel opto-physiological technology designed to non-invasively assess central venous oxygen saturations and rapidly identify patients with circulatory dysfunction. This technology, it is proposed, will be validated in Critical Care populations and subsequently evaluated in Emergency Departments as a predictor of requirement for Critical Care admission.

Centre for International Child Health, British Columbia Children's Hospital and University of British Columbia Faculty of Medicine, Makerere University, Uganda Faculty of Medicine, Mbarara University of Science and Technology, Uganda Ministry of Health, Republic of Uganda Sepsis Alliance

Contact: Drs. Charles Larson Naranjan "Tex" Kissoon

clarson@cw.bc.ca nkissoon@cw.bc.ca

Sepsis is a major contributor to maternal and early childhood mortality. We contend that the development of evidence-based prevention and intervention packages responsive to recognition of sepsis as an emergency requiring early detection and treatment, have the potential to significantly improve maternal and child survival in resource constrained settings, such as Uganda.

Specific Objectives

Create awareness of maternal and early childhood sepsis as major contributors to maternal and under-five mortality in sub-Saharan Africa among health care professionals, governments, funding agencies and the general public.

• Develop, implement and carry out sepsis demonstration projects in rural and urban poor Ugandan districts in collaboration with Ministry of Health, Makerere University College of Health Sciences, Mbarara University of Science and Technology and the Centre for International Child Health, University of British Columbia.
• Create dynamic and effective new partnerships and synergies between public and private health sectors, academia and research facilities.
• To estimate and describe the burden of sepsis in Ugandan Health units and document the factors associated with sepsis.
• To develop and implement appropriate care package to reduce the burden of disease attributed to sepsis in Ugandan primary care health units.
• Generate evidence of effectiveness, impact and cost that will guide policy and program decision-making.
• To strengthen public-private health system partnerships to effectively address the early detection and management of sepsis in women and children.
• Though the support of the GSA and others, disseminate regionally and globally the initiative's experiences, findings and lessons learned.

North Shore LIJ Health System/US Partners to TBD

Contact: Kenneth J. Abrams

KAbrams@NSHS.edu

We face a galvanizing moment in sepsis detection and treatment. Based on the mortality of infectious diseases around the world, sepsis is likely to be proven the leading cause of death worldwide. While there is much good work being done at health care institutions around the US, there is a great and immediate opportunity to reduce the human and economic toll of sepsis by recognizing sepsis as an emergency and rapidly treating patients suspected of sepsis with antibiotics and fluids.

The North Shore LIJ Health system is dedicated to building a US-based partnership initiative to improve awareness of sepsis and drive down mortality through methodological changes in the way sepsis is identified and treated. Our goal is to bring together a founding collaborative of hospitals and health systems, public agencies, patient advocates, policymakers, payors and all of who have a stake in sepsis prevention, detection and treatment.

With a tentative launch date of early-2011, the initiative will focus its efforts on a defined goal: to drive down U.S. sepsis mortality rates by 25% by 2015, saving 175,000 lives.

It is our intention to share challenges and experiences with our GSA colleagues, seek ways to minimize the overlap of efforts and to support the creation of a global data set that will result in recognition of sepsis as the leading cause of death worldwide.

Global Virtual Organization of Intensive Care and Emergency Services Network (Global VOICES Network)

Acutely injured and seriously ill patients around the world are cared for in increasingly sophisticated venues that provide intensive and emergency care. Yet access to critical care services varies around the globe. There are, for example, only 5 ICUs to serve the 40 million people who live in the Sudan, and in many parts of sub-Saharan Africa, family members provide the ventilatory support that mechanical ventilators deliver in the developed world. Although acute care specialists read the same journals, attend the same meetings, and study at schools with largely similar curricula, practice around the world varies, and with this variability in practice come poorly characterized variations in outcome.

Working under the auspices of the World Federation of Societies of Intensive and Critical Care Medicine, its pediatric counterpart, InFACT, and the World Health Organization, we will develop a comprehensive catalog of the clinical and research capacity of all those venues that provide acute care services around the world. This information will permit studies of global epidemiology and practice variability, establish a platform for early detection and monitoring of pandemics and for quantifying the acute care consequences and needs following catastrophes such as earthquakes and floods, and provide a tool for education and dialog amongst acute care practitioners around the world.

Committee to Develop Epidemiological Study

John Marshall: Chairman	MarshallJ@smh.ca
Proposed Members: D. Angus, P. Amin, A. Artigas, D. Bin, V. Dombros E. da Silva, R. Fumagali, J. Hazelzet, J.L. Vincent, G. Martin, T. Kissoon

Undertaking an Epidemiological Study of sepsis is a complex issue as the amount of sepsis, regional differences, risk factors, etc are all confounding factors. A database is required to capture the information. Existing databases and surveys would be very useful such as SOAP, EPPIC II etc. The purpose of the committee is to design and execute a study that is global in scope and includes both adults and children.

Committee to Revise Molecular Definition

Chairman: Steven Opal	Opal@brown.edu
Proposed Members: K. Tracey, S Warren, E. Giamarello-Bourbolis and all ISF members.

The molecular definition needs to account for the following findings:

1) The same pattern recognition receptors and signaling pathways are activated by microbial pathogens (TLRs, NLDs, etc) and by host derived Danger (or Damage)-associated molecular pattern molecules (also known as alarmins). This accounts for the difficulty in distinguishing the systemic response from severe infection from severe trauma, burns, ischemia, pancreatitis, etc)

2) The systemic host response to sepsis is highly variable and is attributable to a complex network of cellular and humoral inflammatory mediators, neuroedocrine factors, vasoactive substances and coagulation factors that jointly participate in microvascular injury, increased vascular permeability, organ dysfunction and septic shock.

3) Multiple predisposing conditions, age, gender, genetic factors, medications, nutritional, site of infection and type of infection, and management choices all contribute to the pattern of organ dysfunction and risk of death following severe infection.

And 4) the immune response is dynamic and exists in a spectrum from hyper-inflammatory to highly immunosuppressed.
Correct treatment requires a real time assessment and rx depending on patient needs.

The International Sepsis Forum has decided to devote one of their ISF Colloquia to this topic and will be inviting all stakeholders to attend. Input from all members of the GSA is sought in preparation.

Committee to Manage Publication Strategy

Chairman: Christopher Czura	cczura@nshs.edu
Proposed Members: Representatives from all GSA organizations

300 M press impressions were generated world wide following the Merinoff Symposium/Meeting of the GSA Congress and the subsequent strategy for a variety of publications. The various papers were:

• Summary paper; authors KR/TN/EJ/KT; destination- Critical Care Medicine. Subject- global impact and public definition.
• Public Survey; author J O'Brien; destination- health affairs publication
• Mortality paper
• Molecular definition
• Themed issue of health affairs targeted at sepsis

It was agreed that there would not be a formal committee for publications but that those willing are invited to sign up to various papers. Chairman, Chris Czura, is the point of contact.

Strategy to Improve Finances & Finance Committee

Chairman: Mark Lambert	mlambert@earthlink.net
Proposed Members: E da Silva, V Giamarellos, J Hazelzet, E Jimenez, K Reinhart, K Shukri

The GSA is operated as an all-volunteer effort. Financial support has thus far come from GSA founding organizations and the Significance Foundation. The GSA's ability to meet its long term goals is dependant on secure meaningful funding.

In that endeavor, the GSA will seek funding both for administrative operations and for projects developed and/or adopted by the GSA (Project Partnerships). Such funding will be sought from all sources deemed appropriate by the Board.

The GSA will not itself, nor will it through its Project Partnerships, be a party to any funding, sponsorship or collaboration which results in the GSA or its Project Partners promoting or advertising products or services including, but not limited to, messages containing qualitative or comparative language, price information, or other indications of savings or value, an endorsement, or an inducement to purchase, sell, or use such products or services.

The GSA will, in any given fiscal year, accept financial support from individual industry sources in amounts up to, but not exceeding, 10% of the GSA's total annual operating budget.

The GSA will adhere to the codes of conduct and principles of transparency established by its member organizations.

All members of the GSA are encouraged to interact with the Committee.