Neurocritical Care in Resource-limited Settings: Challenges and Solutions

Purpose of ReviewThe global burden of neurocritical illness is high. Low- and middle-income countries (LMICs) are disproportionally affected, with higher incidence, higher severity, limited access to care, and worse outcomes compared to high-income countries (HICs). In this review, we describe the current state of neurocritical care in LMICs, review major challenges and highlight potential solutions.Recent FindingsNeurocritical care services in LMICs face significant limitations. Key challenges include inadequate intensive care unit (ICU) infrastructure, limited access to medications, devices, and neuroimaging, a shortage of trained personnel, insufficient prehospital care and transport, and a lack of research and clinical practice guidelines. To address these disparities, targeted interventions are essential. Potential solutions for improving neurocritical care in LMICs include establishing low-cost intermediate care units, developing teleneurocritical care systems to bridge the gap between urban and rural areas, creating cross-border ICU networks, promoting the development of affordable medications, devices, and imaging tools, strategically training specific healthcare workforce, focusing on and building tier 1 emergency medical services, implementing innovative transportation models, establishing local ICU registries, developing context-specific guidelines and protocols, and conducting cost-effectiveness studies that consider the unique needs of LMICs.SummaryMultifaceted collaborative efforts and creative solutions are needed to address the challenges unique to neurocritical care in LMICs.