PROGRAM LEADERS
Pr Elie Azoulay
Prof Elie Azoulay, MD PhD, Department chief, ICU St-Louis hospital, Paris, graduated from the Pierre & Marie Curie University (Paris 6) as an MD and a pulmonologist, then obtained his Intensive Care degree from Paris Diderot University (Paris 7). He completed his research training and obtained a PhD in Respiratory Physiology with the late Alain Harf in Créteil on chemotherapy and G-CSF-related pulmonary toxicity.
In 1996, he joined the team led by Prof Jean-Roger Le Gall in St Louis Hospital in Paris and became one of the most knowledgeable ICU specialists for patients with hematologic malignancies. His research interests are broad and include care of the immunocompromised critically ill, pneumonia, as well as ethical aspects of care, including patient and family needs in critical care. Elie Azoulay has developed a most diverse and comprehensive clinical research agenda, served by research networks he has imagined, created and organized. He has authored more than 800 medical and scientific peer-reviewed papers.
He is the founder in 1996 of the FAMIREA group, a multidisciplinary collaborative network aimed at improving the effectiveness of communication with family members of ICU patients. In 2004, he launched the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique (GRRR-OH) on the management and outcomes of acute respiratory failure in immunocompromised patients. He also leads the RHU (Hospital-University Research Consortium) FAME (Improving FAMily members’ Experience in the intensive care unit), which aims at preventing post-traumatic stress in relatives of ICU patients. This project uses a global approach integrating clinical data, omics, along with educative/informative audio-visual supports, including virtual reality, offered on a dedicated platform (with teleconsultation, online therapy offers, hotline…), of which efficacy is currently evaluated in a randomized trial
Past chair of the ethics section (2010), Past editor in chief of the Intensive Care Medicine journal, Prof. E. Azoulay is the President Elect of the European Society of Intensive Care Medicine – ESICM
STRENGTHS IN THE FOLLOWING AREAS
The AP-HP Nord Hospital group comprises five intensive care departments (ICD) at Lariboisière, Saint-Louis, Bichat, Louis Mourier, Robert Debré (for pediatric intensive care) hospitals, and a functional unit dedicated to digestive intensive care in the Anesthesia-Intensive care Department of Beaujon hospital (welcoming pancreatic and hepatic cancers with acute medical or post-surgical complications), comprising 95 beds and welcoming patients 24 hours a day, 7 days a week, from the whole Northern Paris area (1.5 to 2 million inhabitants: 4500 admissions yearly). These patients are either admitted directly, addressed by emergency Paris area regulation organization (SAMU/SMUR), or transferred from medicine departments of our hospitals (including our ER departments), or from other departments from hospitals of the Greater Paris area, depending of the regional availability in ICU beds. These Intensive care departments comprise 32 FTE senior medical intensivists, and more than 300 paramedical specialized staff.
Among all patients seen in these large departments, nearly 500 present each year with a complication of an underlying, not yet diagnosed cancer, while 350 are cancer patients who are already followed up in the oncology or hematology departments of their hospitals and have been transferred from their referring cancer department for a complication by their oncologist, in accordance with the intensivist team. The medical electronic records of these patients are thus accessible to ICD specialists. Bichat and Louis Mourier ICUs thus welcome mainly lung cancer and digestive cancer patients, the main cancer activities of these hospitals. Beaujon anesthesia ICU welcome pancreatic cancer patients who often deserve complex surgical procedures with frequent complications. Robert Debré exclusively welcome infants followed for hematological malignancies, while Saint-Louis ICU has de the largest cancer ICU activity with solid cancers (lung, digestive, gynecological, urological) and malignant hematological cacners.
In all these hospitals, ICD practitioners are trained to manage acute and sub-acute complications of cancer or of cancer treatments. Beyond such complications, ICD practitioners from the AP-HP.Nord hospital group share three main topics of excellence: chronic respiratory and infectious diseases (Louis Mourier, Bichat, Saint-Louis), and hemato-oncology (Saint-Louis, Bichat).
There are clearly identified pathways for acute severe hemoptysis or hematemesis (arteriography facilities in Bichat, Beaujon, and Saint-Louis Hospitals), including ICD departments for initial follow-up, for febrile neutropenia or lysis syndrome in patients with hematological malignancies from the 9 hematological departments (Saint-Louis hospital), renal failure (all intensive care units [ICU] at Bichat, Saint-Louis, Lariboisière, Louis Mourier, and Beaujon Hospitals).
The five APHP.Nord ICU departments all participate to three large networks:
- OUTCOMEREA, an evolutive database of which goal is to improve health care quality and prevention of nosocomial infection in ICU
- REVA: the European network for study of mechanical ventilation
- CUB REA: the ICUs Greater Paris region database
The adult ICU teams are also active members of scientific societies:
- SRLF: Société de Réanimation de Langue Française
- ESICM: European Society of Intensive Care Medicine
- SPLF: Société de Pneumologie de Langue Française
- SPILF: Société de Pathologie Infectieuse de Langue Française
Beyond these routine activities Saint-Louis ICU has developed specific topics of excellence since constituting a national center of reference for thrombotic micro-angiopathy (TMA) a rare but severe complication occurring in cancer patients as a complication of cancer or of treatments.
Saint-Louis team has also organized a multidisciplinary meeting for managing cancer acute life-threatening complications and toxicities from chemo, targeted or cell biotherapies.
A phone emergency line functioning 24h/24 and 7 days/7 is also available for such complications in cancer patients (SOS ARCHE). Such direct line allows a large activity of specialized advices in cancer acute complication care for the whole greater Paris region and beyond.
Saint-Louis ICU group is also committed to deliver urgent chemotherapy/biotherapy/targeted therapy, to manage their complications, and to offer a care continuity and safety. This service applies to all the hospitals within the AP-HP network. More particularly, in our group that includes four adult university affiliated ICUs and one pediatric affiliated ICU, we have established the Three-Five strategy to align on a) five quality indicators (ratio of admitted/non admitted patients; mortality of patients receiving mechanical ventilation; number of patients receiving anti-cancer therapy; thrombosis/bleeding events and family satisfaction with cancer care in the ICU) ; b) five bedside initiatives (open visit policy for family members; isolation; nurse-physicians discussions; dressing initiatives and early mobilization); and c) five operational standard procedures (disclosing a diagnostic of cancer; antibiotic stewardship; oxygenation and ventilation management; transfusion policies and G-CSF administration).
Basic science :
Existing intercations:
INSERM 976 basic science (Lara Zafrani)
INSERM U1153 – Equipe ECSTRRA (Elie Azoulay & Michael Darmon) epidemiology and biostatistics
In terms of education, the master degree on ICU care of cancer patients (100 hours in 11 sessions, 120 delegates), in French, already welcomes 50-60 oncologists or hematologists every year. Similarly, our annual training in English named the BDI (Blood Diseases in the ICU) that attracts >50 international delegates from European and non-European countries will allow more international collaboration.
International visibility achieved by the ICU from the Saint-Louis Hospital and the GRRR-OH
- The Saint-Louis intensive care department is leading European and international teaching programs about cancer critical care. Its members are involved in Europe, the USA, Canada, as well as in South America (Brazil, Chile). They are invited to lecture on cancer critical care at every annual critical care conference and every training session in these countries. The GRRR-OH website (https://www.grrroh.fr/en/) (in French/ English) is visited by >10,000 physicians every year.
- The international Nine-I study group led by Elie Azoulay have been created, that includes 68 ICUs in 16 countries with which large cohort studies are developed and are now in the process of applying for grants to perform randomized controlled trials (currently about platelet transfusions and about diagnostic strategy in acute respiratory failure). This group has published >15 articles, including three statements and position papers about the management of critically ill cancer patients.
- Every year in January Saint-Louis’ team welcome to Paris about 50 international delegates (among >300 requests) for a training course named “Blood Diseases in the ICU”. In an entire week (50 hours) lectures are delivered by international speakers on all the aspects of hematology in the ICU, with a warm ambiance and good interactions. Based on the demand, a second session is likely to be organized in June. This course in English is different than the master degree on cancer critical care (Paris Cité University) that the team delivers each year (100 hours ventilated in 12 modules).
- Every year, the last week of March 2-day meeting is organized by the group with the development of research projects, of position papers, followed by a day on lectures from international experts.
- The GRRR-OH has led or has taken responsibilities in developing expert statements or guidelines on the management of critically ill cancer patients. The most recent has been published in Leukemia (Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation, from the 2021 European Conference on Infections in Leukaemia (ECIL 9).
- To extend this international research group, an interest group at the European Society of Intensive Care Medicine (a working group that goes beyond one specialty) will be created in 2023
- Every year three international research fellows are welcome who work on clinical research projects or in the lab. These researchers can be clinicians or pure researchers in the field of cancer.
- GRRR-OH is part of the jury of international calls for research funding in Canada, USA and in Denmark and has published >100 papers in critical care, oncology or hematology peer reviewed journals with high impact factor
- Over the last years, during the COVID-19 pandemic that surged on ICU services, GRRR-OH group has been asked to work with other international groups to provide guidance on the management of severe COVID-19 ARDS in cancer patients.