Clinician praised for saving lives in intensive care

18 October 2018

Clinician praised for saving lives in intensive care through research

Thousands of patients in Intensive Care Units (ICUs) have benefited from the clinical trials led in New Zealand by Auckland City Hospital intensive care specialist and clinical researcher Dr Colin McArthur.

For more than two decades, Dr McArthur and his colleagues have questioned and tested treatment options available to critically-ill patients in the ICU, to reveal the safest, most effective ways to treat illnesses that pose a threat to life.

Many of these trials have changed guidelines and clinical practices in ICUs worldwide, and last night they earned Dr McArthur the Health Research Council of New Zealand’s (HRC) Beaven Medal for excellence in translational health research.

The award, presented at the Royal Society Te Apārangi 2018 Research Honours Aotearoa, not only recognises the impact of Dr McArthur and his colleagues’ work on patient care, but in establishing the ICU as a place where much-needed research is done and is making a difference.

In presenting the Award, HRC chief executive Professor Kath McPherson, praised Dr

McArthur’s success in driving translational research and inspiring other clinicians to do so.

“He’s shown outstanding leadership in his field and created a process where robust, well-powered clinical evidence can help deliver the best possible outcomes for the critically ill. And he’s done it all from the frontline of clinical care,” she said.

Prior to 1994 and the formation of the Australia and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG), clinical research was uncommon in New Zealand ICUs. It was in 1996 – when Dr McArthur joined this group and became the New Zealand lead on large-scale multi-centre trials across New Zealand, Australia and further afield – that things started to change.

The ANZICS CTG’s first randomised controlled trial, published in The Lancet in 2000, looked into low-dose dopamine, a common treatment at the time for protection against kidney failure. The trial found that low-dose dopamine did not influence the progression of acute kidney injury, and consequently the treatment was removed from guidelines and clinical practice in ICUs worldwide.

From there, Dr McArthur and his colleagues at the ANZICS CTG gained their first major grant from the Health Research Council and the Australian National Health and Medical Research Council to investigate whether the choice of resuscitation fluids for patients in ICUs affected survival.

The SAFE study evaluated the risk of death in 7000 patients (in 16 ICUs) receiving expensive albumin fluid versus those receiving simple saline fluid, and found that both treatments resulted in similar outcomes (in fact albumin was found to be harmful in a sub-set of patients). Published in the New England Journal of Medicine in 2004, the study was described as ‘not only a landmark trial, but also a milestone for the discipline of critical care medicine… heralding a new era in critical care marked by the large, simple randomised trial’.

Dr McArthur and colleagues have since gained HRC project funding for a host of trials that have been published and recognised internationally, and in 2016 he was the first fulltime hospital clinician to successfully win an HRC-funded five-year programme grant.

He says, through this funding support, lives have been saved and New Zealand has been able to develop research capability in intensive care clinicians and trainees, ensuring the long-term sustainability of research in the ICU. “Because of the systems and processes we’ve put in place, clinicians now have a process and system for answering questions that they see every day.”

He adds that with the Medical Research Institute of New Zealand coordinating and managing the trials undertaken, New Zealand ICU clinicians are increasingly leading the charge on a number of studies and are now inviting other countries to join their trials.

He says receiving the Beaven Medal is a group achievement. “The Medal acknowledges not just me and the many others involved, but also that intensive care research has come of age; that it is a strong player in the clinical research space, and we’re seeing its impact on the wider international stage. It’s good to see we’ve made that transition and it’s now being acknowledged.”

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