Vital research for critically ill patients

Thursday 7 June 2012

Media Release

Vital research for critically ill patients

The Health Research Council of New Zealand (HRC) has announced $65.2M of government research funding investment into issues that impact most heavily on the health of New Zealanders.

Clinicians from District Health Boards (DHBs) across the country have received funding from the Health Research Council of New Zealand (HRC) to carry out research which aims to answer unresolved clinical questions that challenge health professionals caring for patients in emergency departments, intensive care units and surgical wards. These research projects all have strong links with world leading clinical researchers from overseas, reflecting the quality of the research and the global importance of the evidence that will be provided.

Associate Professor Timothy Short and colleagues from the Auckland DHB will conduct a large scale randomised clinical trial to answer definitively the question of whether anaesthetic depth alters surgical outcome. There are over 450,000 general anaesthetics administered every year in New Zealand, but the optimal depth of anaesthetia is unknown. Observational studies have shown a 20 per cent increase in mortality in moderate or high risk patients undergoing major surgery who receive relatively deep anaesthesia, but this needs to be balanced against a possible increase in the risk of awareness if patients are given lower doses of anaesthetic drugs.
The study will look at the impact of ‘light’ versus ‘deep’ anaesthesia on death rate and complications such as wound infection, cardiovascular and neurological problems, pain and awareness. The research team includes world leading anaesthetic clinical researchers from Australia and Hong Kong, and the results will have global implications for how anaesthetia is conducted.

Dr Colin McArthur from the Auckland DHB will lead a team of investigators from intensive care units across the country to investigate whether using ‘fresher’ red blood cells for transfusions will improve outcomes in critically ill patients. Red blood cell transfusion is a common and potentially life-saving treatment; however, blood stored for a prolonged time deteriorates and previous studies suggest that ‘older’ blood may worsen outcomes in critically ill patients.
This Australasian study will randomly assign 5,000 patients in intensive care in New Zealand and Australia requiring transfusion to receive either the freshest available blood or current standard issue older blood to determine if the age of blood transfused affects survival and other clinical outcomes.

The study will be undertaken in collaboration with the New Zealand Blood Service, and if adverse effects of older blood are demonstrated, then the national standards for the age of blood to be provided for critically ill patients will be revised.

In a second study, Dr McArthur will also lead the New Zealand contingent of an Australasian team who seek to answer a fundamental clinical question that has challenged clinicians caring for critically ill patients for the last 40 years. ‘Septic shock’ is a common complication of infection and a major cause of mortality worldwide, with a case fatality rate in developed countries of 25 – 30 per cent. Treatment with steroids (cortisone-like medicines) can reverse the shock, but it remains uncertain if their use improves survival overall as they carry a risk of serious complications in the critically ill. The placebo-controlled study of low-dose hydrocortisone in critically ill patients will determine if this treatment improves survival and quality of life up to six months after initial illness. This study would be the largest of its kind to date and it will inform policy and practice in Australia and New Zealand and around the world.

Dr Martin Than will lead a multi-disciplinary team of clinicians and management from the Canterbury DHB who seek to improve the medical decision-making process for patients who present to Emergency Departments with chest pain that is possibly due to a heart attack. The randomised trial aims to prove the effectiveness of a new ‘fast-track’ pathway (accelerated diagnostic protocol), which incorporates a new risk score and will allow earlier rule-out of heart attack and improve the rate of early discharge from Emergency Departments. This outcome is beneficial to both patients and the health service, by reassuring patients earlier that heart attack has been ruled-out and by avoiding unnecessary admissions, duplication of staff activities, and reducing pressure upon urgent care services. The involvement of international research leaders in the research represents forward planning for international dissemination if the study findings are positive.

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2012 HRC annual funding round results
The HRC processed 180 full applications for four different types of awards and will offer 51 contracts to the successful applicants. Project proposals were processed through a two-stage process beginning with 378 Expressions of Interest leading to 97 full applications assessed in the second stage. Successful applications were chosen by an assessment process involving national and international expert referees, detailed discussion by Science Assessing Committees, and further review by the Grant Approval Committee before final approval by the HRC Board. The total value of new research to be undertaken within universities, research institutes and District Health Boards is $65.2 million (excluding GST). For detailed results, please visit the HRC website, www.hrc.govt.nz.

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