Cardiovascular Anesthesia and Critical Care in the French West Indies: Historical Evolution and Current Prospects

Abstract

Anesthesiology, the medical specialty that deals with the management of vital functions in patients undergoing surgery, has played an important role in the successful development of cardiac interventions worldwide. Tracing the historical roots of cardiac anesthesia and critical care from its inception in the late 1950s, a paradigm shift in perioperative care has been driven by a better understanding of the mechanisms of organ dysfunction in stressful conditions and technological advances regarding surgical approach, patient monitoring, and organ protection. Although progress in cardiac anesthesia and critical care lagged a little behind in Caribbean territories, successful achievements have been accomplished over the last forty years. Compared with Western countries, the greater prevalence of obesity, diabetes mellitus, and hypertension as well as specific diseases such as cardiac amyloidosis, sickle cell anemia, rheumatic heart disease, and tropical infections may reduce a patient's physiologic reserve and increase the operative risk among the multi-ethnic population living in the French West Indies and Guiana. So far, cardiac anesthesiologists at the University Hospital of Martinique have demonstrated their abilities in implementing evidence-based clinical care processes and adaptating to efficiently working in a complex environment interacting with multiple partners. Attracting specialized physicians in dedicated cardiac surgical centers and the creation of a regional health network supported by governmental authorities, insurance companies, and charitable organizations are necessary to solve the unmet needs for invasive cardiac treatments in the Caribbean region.

Keywords: Caribbean territories; cardiac surgery; cardiopulmonary bypass; extracorporeal membrane oxygenation: air ambulance transportation; interventional cardiology.

Figure 1

The Caribbean cardiovascular network organized with the University Hospital in Martinique (Fort de France) and hospitals located in other French territories (St. Martin, Guadeloupe, and French Guiana) and some neighboring islands (St. Lucie and Dominique). The distance between these remote locations and Fort de France is expressed in km.

Figure 2

Aerial view of Pierre Zobda Quitman Hospital and Mothers–Women–Children Hospital, the main site of the University Hospital of Martinique in Fort de France.

Figure 3

Illustration of key milestones in the development of cardiovascular surgery associated with the emergence of cardiac anesthesia and critical care at the University Hospital of Martinique. CVVHF, continuous veno-venous hemofiltration; CPB, cardiopulmonary bypass; ERAS, enhanced recovery after surgery; GIK, glucose–insulin–potassium; ICU, intensive care; LVAD, left ventricular assist device; OR, operating room; POC, point-of-care; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.

Figure 4

Air ambulance and ECMO mobile team with a critically ill patient.

Figure 5

Intensive care station equipped with modern ventilators, advanced hemodynamic monitoring, continuous veno-venous hemofiltration, and extracorporeal life-support device.