Ana Maria Crawford

All Publications

• A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive care medicine Spencer, S. A., Adipa, F. E., Baker, T., Crawford, A. M., Dark, P., Dula, D., Gordon, S. B., Hamilton, D. O., Huluka, D. K., Khalid, K., Lakoh, S., Limbani, F., Rylance, J., Sawe, H. R., Simiyu, I., Waweru-Siika, W., Worrall, E., Morton, B. 2023

  Abstract

  There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.

  View details for DOI 10.1007/s00134-023-07136-2

  View details for PubMedID 37428213

• Global critical care: a call to action. Critical care (London, England) Crawford, A. M., Shiferaw, A. A., Ntambwe, P., Milan, A. O., Khalid, K., Rubio, R., Nizeyimana, F., Ariza, F., Mohammed, A. D., Baker, T., Banguti, P. R., Madzimbamuto, F. 2023; 27 (1): 28

  Abstract

  Critical care is underprioritized. A global call to action is needed to increase equitable access to care and the quality of care provided to critically ill patients. Current challenges to effective critical care in resource-constrained settings are many. Estimates of the burden of critical illness are extrapolated from common etiologies, but the true burden remains ill-defined. Measuring the burden of critical illness is epidemiologically challenging but is thought to be increasing. Resources, infrastructure, and training are inadequate. Millions die unnecessarily due to critical illness. Solutions start with the implementation of first-step, patient care fundamentals known as Essential Emergency and Critical Care. Such essential care stands to decrease critical-illness mortality, augment pandemic preparedness, decrease postoperative mortality, and decrease the need for advanced level care. The entire healthcare workforce must be trained in these fundamentals. Additionally, physician and nurse specialists trained in critical care are needed and must be retained as leaders of critical care initiatives, researchers, and teachers. Context-specific research is mandatory to ensure care is appropriate for the patient populations served, not just duplicated from high-resourced settings. Governments must increase healthcare spending and invest in capacity to treat critically ill patients. Advocacy at all levels is needed to achieve universal health coverage for critically ill patients.

  View details for DOI 10.1186/s13054-022-04296-3

  View details for PubMedID 36670506

• An audit of the carbon footprint of travel for the Canadian Anesthesiologists' Society International Education Foundation partnerships. Canadian journal of anaesthesia = Journal canadien d'anesthesie Chibane, S., Ryan, T., Nizeyimana, F., Gill, O., Abate, A., Hamstra, J., Crawford, A., Barnbrook, J., Bould, M. D. 2023

  Abstract

  International partnerships have an important role in capacity building in global health, but frequently involve travel and its associated carbon footprint. The environmental impact of global health partnerships has not previously been quantified.We conducted a retrospective internal audit of the environmental impact of air travel for the international education programs of the Canadian Anesthesiology Society's International Education Fund (CASIEF). We compiled a comprehensive list of volunteer travel routes and used the International Civil Aviation Organization Carbon Emissions Calculator, which considers travel distance, passenger numbers, and average operational data for optimized estimates. Comparisons were made with average Canadian household emissions and disability adjusted life years (DALYs) lost from climate change consequences.The total carbon dioxide emitted (CO2-e) for the Rwanda, Ethiopia, and Guyana CASIEF partnerships were 268.2, 60.7, and 52.0 tons, respectively. The DALYs cost of these programs combined is estimated to be as high as 1.1 years of life lost due to the effects of CO2-e. The mean daily carbon cost of the average Rwanda partnership was equivalent to daily emissions of 2.2 Canadians (or 383 Rwandans), for the Guyana partnership was equivalent to 1.6 Canadians (or 7.6 Guyanese people), and for the Ethiopia partnership was equivalent to 2.4 Canadians (or 252 Ethiopian people).Air travel from these CASIEF partnerships resulted in 380.9 tons CO2-e but also enabled 5,601 volunteer days-in-country since 2014. The estimated environmental cost needs to be balanced against the impact of the programs. Regardless, carbon-reduction remains a priority, whether by discouraging premium class travel, organizing longer trips to reduce daily emissions, prioritizing remote support and virtual education, or developing partnerships closer to home.

  View details for DOI 10.1007/s12630-022-02388-w

  View details for PubMedID 36670316

• Surviving Sepsis Campaign 2021 Updates for Management of Sepsis and Septic Shock ASA Monitor Crawford, A. M. 2023; 87 (30)
• Anesthesia Fellowship Programs in Global Health: An Update ASA Monitor Park, S., Arteaga, M., Percy, S., Crawford, A. 2023; 87: 24-25

  View details for DOI 10.1097/01.ASM.0000924988.69928.fa

• ASA Global Health Overseas Training Programs: A Rwanda Update ASA Monitor Asher, S. R., Crawford, A. M. 2023; 87: 22

  View details for DOI 10.1097/01.ASM.0000924980.08965.a9

• The Value of Global Engagement ASA Monitor Crawford, A. M., Belani, K. G., Drum, E. T. 2023; 87: 16-17

  View details for DOI 10.1097/01.ASM.0000924964.09020.06

• Remote Education: Opportunity in Necessity Update in Anaesthesia Morley, R., Crawford, A. M., Abdel-Rahman El-Refai, N. 2022; 36
• Barriers to Effective Transfusion Practices in Low-Resourced Settings: From Infrastructure to Cultural Beliefs Crawford, A., Mohammad, A., Ntambwe, P. LIPPINCOTT WILLIAMS & WILKINS. 2021: 680-681

  View details for Web of Science ID 000713327100489

• Global Includes Local ASA Monitor Crawford, A., Jensen, A. 2021; 85: 21-22

  View details for DOI 10.1097/01.ASM.0000733844.67336.ec

• Assessment of intraoperative temperature management at the University Teaching Hospital of Kigali: A quality improvement project World Journal of Advanced Research and Reviews Flannery, K., Uwimana, J., Nikuze, C., Uwineza, J., Crawford, A. M. 2021; 09 (01): 97-103

  View details for DOI 10.30574/wjarr.2021.9.1.0502

• Global Health Without Travel? Reframing Global Health for Anesthesiologists Crawford, A. M., Singleton, M., Sanghvi, R. California Society of Anesthesiologists. 2021 ; CSA Vital Times Annual Report
• Correction to: Barriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs. World journal of surgery Mohammed, A. D., Ntambwe, P., Crawford, A. M. 2020

  Abstract

  The article "Barriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs".

  View details for DOI 10.1007/s00268-020-05692-y

  View details for PubMedID 32705534

• Barriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs. World journal of surgery Mohammed, A. D., Ntambwe, P., Crawford, A. M. 2020

  Abstract

  BACKGROUND: Surgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high-income countries (HICs), over eighty percent of the global population lives outside of these countries. High-income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low-income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. In LICs, greater than 50% of blood is administered to children under 5years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice.METHODS: In January 2019, a 10-question survey was sent electronically to physician anesthesiologists working in low- and middle-income countries to examine resources and practice patterns for blood transfusion. Subsequent discussions illustrate obstacles contributing to low availability of blood products and illuminate infrastructure and cultural barriers preventing optimal transfusion practices.SURVEY RESULTS: Acquiring whole blood takes hours. Clinicians wait days to receive packed red blood cells or platelets. Fresh frozen plasma is available but untimely. For many, protocols for massive transfusion are rare, and for transfusion, ratios are nonexistent. Complete blood counts take hours, and coagulation profiles are severely delayed.DISCUSSION OF INFRASTRUCTURE AND CULTURAL BARRIERS: With few voluntary, unpaid, donors and inconsistent supply of testing kits, donated blood is unsafe.Donors are seasonal for farming communities, endemic malaria areas, and student donors recruited through schools.Cultural beliefs fuel distrust.Transfusion specialists, concentrated in urban areas, see rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.

  View details for DOI 10.1007/s00268-020-05461-x

  View details for PubMedID 32157404

• California Programs Address Global Needs and Enrich the Career Development of Young Anesthesiologists: California Society of Anesthesiologists Singleton, M., Crawford, A., Duperrault, M., et al California Society of Anesthesiologists. 2019 ; CSA Vital Times Annual Report
• Considerations in Developing Thoughtful Anesthesia Global Health Programs ASA Monitor Duperrault, M., McGoldrick, R., Crawford, A. 2018; 82 (4): 50
• Bi-directional International Resident Scholar Exchange: Is it Valuable? ASA Monitor Crawford, A. M., Mets, B. 2018; 82 (10)
• ASA Global Humanitarian Outreach Overseas Teaching Program: Rwandan versus American Perspective ASA Monitor Crawford, A. M., Bangui, P., Uwambazimana, J. D. 2017; 81: 46 – 50
• Global Health Fellowships American Society of Anesthesiologists Newsletter McGoldrick, R., Crawford, A. M., McQueen, K. q. 2015; 79 (3)
• Editorial comment: anesthetic management of a malnourished, 7-year-old child in Malawi undergoing a pneumonectomy. A & A case reports Crawford, A. M. 2014; 3 (6): 72-?

  View details for DOI 10.1213/XAA.0000000000000087

  View details for PubMedID 25611523

• Modulatory effects of hypercapnia on in vitro and in vivo pulmonary endothelial-neutrophil adhesive responses during inflammation CYTOKINE Liu, Y., Chacko, B. K., Ricksecker, A., Shingarev, R., Andrews, E., Patel, R. P., Lang, J. D. 2008; 44 (1): 108–17

  Abstract

  Reducing tidal volume as a part of a protective ventilation strategy may result in hypercapnia. In this study, we focused on the influence of hypercapnia on endothelial-neutrophil responses in models of inflammatory-stimulated human pulmonary microvascular endothelial cells (HMVEC) and in an animal model of lipopolysaccharide (LPS)-induced acute lung injury. Neutrophil adhesion and adhesion molecules expression and nuclear factor-kappaB (NF-kappaB) were analyzed in TNF-alpha and LPS-treated HMVEC exposed to either eucapnia or hypercapnia. In the in vivo limb, bronchoalveolar lavage fluid cell counts and differentials, adhesion molecule and chemokine expression were assessed in LPS-treated rabbits ventilated with either low tidal volume ventilation and eucapnia or hypercapnia. In both the in vitro and in vivo models, hypercapnia significantly increased neutrophil adhesion and adhesion molecule expression compared to eucapnia. Activity of NF-kappaB was significantly enhanced by hypercapnia in the in vitro experiments. IL-8 expression was greatest both in vitro and in vivo under conditions of hypercapnia and concomitant inflammation. CD11a expression was greatest in isolated human neutrophils exposed to hypercapnia+LPS. Our results demonstrate that endothelial-neutrophil responses per measurement of fundamental molecules of adhesion are significantly increased during hypercapnia and that hypercapnia mimics conditions of eucapnia+inflammation.

  View details for DOI 10.1016/j.cyto.2008.06.016

  View details for Web of Science ID 000260700600018

  View details for PubMedID 18713668

  View details for PubMedCentralID PMC2610255

• Fluid Management: Minimization versus Goal-Directed Therapy American Society of Anesthesiologists Newsletter Crawford, A. ., Joshi, G. P. 2008; 72 (4)
• Perioperative Ventilation Strategies: New modes and monitoring features in anesthesia ventilators improve management of challenging patients, situations. Acuity Care Technology Beckham, J., Crawford, A., Joshi, G. 2006