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Young PJ, Hodgson CL, Mackle D, Mather AM, Beasley R, Bellomo R, Bernard S, Brickell K, Deane AM, Eastwood G, Finfer S, Higgins AM, Hunt A, Lawrence C, Linke NJ, Litton E, McDonald CF, Moore J, Nichol AD, Olatunji S, Parke RL, Peake S, Secombe P, Seppelt IM, Turner A, Trapani T, Udy A, Kasza J. Protocol summary and statistical analysis plan for the low oxygen intervention for cardiac arrest injury limitation (LOGICAL) trial. CRIT CARE RESUSC 2023; 25:140-146. [PMID: 37876368 PMCID: PMC10581260 DOI: 10.1016/j.ccrj.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background The effect of conservative vs. liberal oxygen therapy on outcomes of intensive care unit (ICU) patients with hypoxic ischaemic encephalopathy (HIE) is uncertain and will be evaluated in the Low Oxygen Intervention for Cardiac Arrest injury Limitation (LOGICAL) trial. Objective The objective of this study was to summarise the protocol and statistical analysis plans for the LOGICAL trial. Design setting and participants LOGICAL is a randomised clinical trial in adults in the ICU who are comatose with suspected HIE (i.e., those who have not obeyed commands following return of spontaneous circulation after a cardiac arrest where there is clinical concern about possible brain damage). The LOGICAL trial will include 1400 participants and is being conducted as a substudy of the Mega Randomised registry trial comparing conservative vs. liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX). Main outcome measures The primary outcome is survival with favourable neurological function at 180 days after randomisation as measured with the Extended Glasgow Outcome Scale (GOS-E). A favourable neurological outcome will be defined as a GOS-E score of lower moderate disability or better (i.e. a GOS-E score of 5-8). Secondary outcomes include survival time, day 180 mortality, duration of invasive mechanical ventilation, ICU length of stay, hospital length of stay, the proportion of patients discharged home, quality of life assessed at day 180 using the EQ-5D-5L, and cognitive function assessed at day 180 using the Montreal Cognitive Assessment (MoCA-blind). Conclusions The LOGICAL trial will provide reliable data on the impact of conservative vs. liberal oxygen therapy in ICU patients with suspected HIE following resuscitation from a cardiac arrest. Prepublication of the LOGICAL protocol and statistical analysis plan prior to trial conclusion will reduce the potential for outcome-reporting or analysis bias. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12621000518864).
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Affiliation(s)
- Paul J. Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Anne M. Mather
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Victorian Heart Hospital, Melbourne, Victoria, Australia
| | - Kathy Brickell
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
| | - Adam M. Deane
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Glenn Eastwood
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University College London, London, United Kingdom
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Anna Hunt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Cassie Lawrence
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Natalie J. Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Edward Litton
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Intensive Care Unit, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
| | - Christine F. McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - James Moore
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - Shaanti Olatunji
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rachael L. Parke
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Sandra Peake
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Secombe
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Ian M. Seppelt
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
| | - Anne Turner
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - for the LOGICAL management committee, the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Irish Critical Care Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyperbaric Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Intensive Care, Victorian Heart Hospital, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University College London, London, United Kingdom
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Intensive Care Unit, Fiona Stanley Hospital, Robin Warren Drive, Murdoch, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Intensive Care Unit, Nepean Hospital, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ross P, Watterson J, Fulcher BJ, Linke NJ, Nicholson AJ, Ilic D, Hodgson CL. Nursing workforce, education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: A qualitative substudy. Aust Crit Care 2023; 36:114-118. [PMID: 35016842 DOI: 10.1016/j.aucc.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units. METHODS This was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service. RESULTS Four themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles. CONCLUSION This study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.
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Affiliation(s)
- Paul Ross
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Jason Watterson
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
| | - Bentley J Fulcher
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Natalie J Linke
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | | | - Dragan Ilic
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Carol L Hodgson
- Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
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Hodgson CL, Higgins AM, Bailey MJ, Anderson S, Bernard S, Fulcher BJ, Koe D, Linke NJ, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Sheldrake J, Reddi BAJ, Stub D, Trapani TV, Udy AA, Serpa Neto A. Incidence of death or disability at 6 months after extracorporeal membrane oxygenation in Australia: a prospective, multicentre, registry-embedded cohort study. Lancet Respir Med 2022; 10:1038-1048. [PMID: 36174613 DOI: 10.1016/s2213-2600(22)00248-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is an invasive procedure used to support critically ill patients with the most severe forms of cardiac or respiratory failure in the short term, but long-term effects on incidence of death and disability are unknown. We aimed to assess incidence of death or disability associated with ECMO up to 6 months (180 days) after treatment. METHODS This prospective, multicentre, registry-embedded cohort study was done at 23 hospitals in Australia from Feb 15, 2019, to Dec 31, 2020. The EXCEL registry included all adults (≥18 years) in Australia who were admitted to an intensive care unit (ICU) in a participating centre at the time of the study and who underwent ECMO. All patients who received ECMO support for respiratory failure, cardiac failure, or cardiac arrest during their ICU stay were eligible for this study. The primary outcome was death or moderate-to-severe disability (defined using the WHO Disability Assessment Schedule 2.0, 12-item survey) at 6 months after ECMO initiation. We used Fisher's exact test to compare categorical variables. This study is registered with ClinicalTrials.gov, NCT03793257. FINDINGS Outcome data were available for 391 (88%) of 442 enrolled patients. The primary outcome of death or moderate-to-severe disability at 6 months was reported in 260 (66%) of 391 patients: 136 (67%) of 202 who received veno-arterial (VA)-ECMO, 60 (54%) of 111 who received veno-venous (VV)-ECMO, and 64 (82%) of 78 who received extracorporeal cardiopulmonary resuscitation (eCPR). After adjustment for age, comorbidities, Acute Physiology and Chronic Health Evaluation (APACHE) IV score, days between ICU admission and ECMO start, and use of vasopressors before ECMO, death or moderate-to-severe disability was higher in patients who received eCPR than in those who received VV-ECMO (VV-ECMO vs eCPR: risk difference [RD] -32% [95% CI -49 to -15]; p<0·001) but not VA-ECMO (VA-ECMO vs eCPR -8% [-22 to 6]; p=0·27). INTERPRETATION In our study, only a third of patients were alive without moderate-to-severe disability at 6 months after initiation of ECMO. The finding that disability was common across all areas of functioning points to the need for long-term, multidisciplinary care and support for surviving patients who have had ECMO. Further studies are needed to understand the 180-day and longer-term prognosis of patients with different diagnoses receiving different modes of ECMO, which could have important implications for the selection of patients for ECMO and management strategies in the ICU. FUNDING The National Health and Medical Research Council of Australia.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Denise Koe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jasmin V Board
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Daniel Brodie
- Department of Medicine and Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons, NY, USA; New York-Presbyterian Hospital, New York, NY, USA
| | - Heidi Buhr
- Intensive Care Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Aidan J C Burrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - John F Fraser
- School of Medicine, University of Queensland, St Lucia, QLD, Australia; Critical Care Research Group, Adult Intensive Care Society, Prince Charles Hospital, Chermside, QLD, Australia
| | - David J Gattas
- Intensive Care Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ingrid K Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sue Huckson
- Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Shay P McGuinness
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; Medical Research Institute of New Zealand, Wellington, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Neil Orford
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia; School of Medicine, Deakin University, Geelong Waurn Ponds, VIC, Australia
| | - Rachael L Parke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; Medical Research Institute of New Zealand, Wellington, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Jayne Sheldrake
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Tony V Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia; Intensive Care Unit, Austin Hospital, Melbourne, VIC, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, Bissett B, Boden IJ, Bradley S, Burrell A, Cooper DJ, Fulcher BJ, Haines KJ, Hodgson IT, Hopkins J, Jones AYM, Lane S, Lawrence D, van der Lee L, Liacos J, Linke NJ, Gomes LM, Nickels M, Ntoumenopoulos G, Myles PS, Patman S, Paton M, Pound G, Rai S, Rix A, Rollinson TC, Tipping CJ, Thomas P, Trapani T, Udy AA, Whitehead C, Anderson S, Neto AS. Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non-COVID-19 Critical Illness. Am J Respir Crit Care Med 2022; 205:1159-1168. [PMID: 35258437 PMCID: PMC9872799 DOI: 10.1164/rccm.202110-2335oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Rationale: The outcomes of survivors of critical illness due to coronavirus disease (COVID-19) compared with non-COVID-19 are yet to be established. Objectives: We aimed to investigate new disability at 6 months in mechanically ventilated patients admitted to Australian ICUs with COVID-19 compared with non-COVID-19. Methods: We included critically ill patients with COVID-19 and non-COVID-19 from two prospective observational studies. Patients were eligible if they were adult (age ⩾ 8 yr) and received ⩾24 hours of mechanical ventilation. In addition, patients with COVID-19 were eligible with a positive laboratory PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Measurements and Main Results: Demographic, intervention, and hospital outcome data were obtained from electronic medical records. Survivors were contacted by telephone for functional outcomes with trained outcome assessors using the World Health Organization Disability Assessment Schedule 2.0. Between March 6, 2020, and April 21, 2021, 120 critically ill patients with COVID-19, and between August 2017 and January 2019, 199 critically ill patients without COVID-19, fulfilled the inclusion criteria. Patients with COVID-19 were older (median [interquartile range], 62 [55-71] vs. 58 [44-69] yr; P = 0.019) with a lower Acute Physiology and Chronic Health Evaluation II score (17 [13-20] vs. 19 [15-23]; P = 0.011). Although duration of ventilation was longer in patients with COVID-19 than in those without COVID-19 (12 [5-19] vs. 4.8 [2.3-8.8] d; P < 0.001), 180-day mortality was similar between the groups (39/120 [32.5%] vs. 70/199 [35.2%]; P = 0.715). The incidence of death or new disability at 180 days was similar (58/93 [62.4%] vs. 99/150 [66/0%]; P = 0.583). Conclusions: At 6 months, there was no difference in new disability for patients requiring mechanical ventilation for acute respiratory failure due to COVID-19 compared with non-COVID-19. Clinical trial registered with www.clinicaltrials.gov (NCT04401254).
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Affiliation(s)
- Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and,Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Alisa M. Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Michael J. Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Anne M. Mather
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lisa Beach
- Department of Physiotherapy (Allied Health), the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Critical Care, School of Medicine, and,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia;,Physiotherapy Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ianthe J. Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia;,School of Medicine, University of Tasmania, Tasmania, Australia
| | - Scott Bradley
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - D. James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - Bentley J. Fulcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Kimberley J. Haines
- Department of Critical Care, School of Medicine, and,Physiotherapy Department, Western Health, Melbourne, Victoria, Australia
| | - Isabelle T. Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Jack Hopkins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Alice Y. M. Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Lane
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Drew Lawrence
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | | | - Jennifer Liacos
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Natalie J. Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Lonni Marques Gomes
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Marc Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | | | - Paul S. Myles
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shane Patman
- Faculty of Medicine, Nursing and Midwifery, Health Sciences, and Physiotherapy, the University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia
| | - Gemma Pound
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Physiotherapy Department, St. Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Sumeet Rai
- Canberra Health Services, Canberra, Australian Capital Territory, Australia;,Medical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Alana Rix
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Thomas C. Rollinson
- Medical School, Australia National University, Canberra, Australian Capital Territory, Australia;,Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Claire J. Tipping
- Department of Physiotherapy, the Alfred, Melbourne, Victoria, Australia
| | - Peter Thomas
- Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Andrew A. Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Intensive Care and Hyperbaric Medicine and
| | - Christina Whitehead
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Intensive Care Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine,,Department of Critical Care, School of Medicine, and,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia;,Department of Physiotherapy, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia; and
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Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, Bissett B, Boden IJ, Bradley S, Burrell A, Cooper DJ, Fulcher BJ, Haines KJ, Hopkins J, Jones AYM, Lane S, Lawrence D, van der Lee L, Liacos J, Linke NJ, Gomes LM, Nickels M, Ntoumenopoulos G, Myles PS, Patman S, Paton M, Pound G, Rai S, Rix A, Rollinson TC, Sivasuthan J, Tipping CJ, Thomas P, Trapani T, Udy AA, Whitehead C, Hodgson IT, Anderson S, Neto AS. The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study. Crit Care 2021; 25:382. [PMID: 34749756 PMCID: PMC8575157 DOI: 10.1186/s13054-021-03794-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia.
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia.
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia
| | - Anne M Mather
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa Beach
- Department of Physiotherapy (Allied Health), The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
| | - Bernie Bissett
- Discipline of Physiotherapy, University of Canberra, Canberra, Australia
- Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Ianthe J Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Tasmania, Australia
- Launceston Clinical School, University of Tasmania, Tasmania, Australia
| | - Scott Bradley
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Aidan Burrell
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia
| | - Jack Hopkins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Stuart Lane
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Intensive Care Medicine Nepean Hospital, New South Wales, Australia
| | - Drew Lawrence
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | | | - Jennifer Liacos
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lonni Marques Gomes
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marc Nickels
- Physiotherapy Department, Princess Alexandra Hospital, Metro South Health, Queensland, Australia
| | | | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shane Patman
- Faculty of Medicine, Nursing and Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia
| | - Gemma Pound
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Sumeet Rai
- Canberra Health Services, Canberra, Australia
- Medical School, Australia National University, Canberra, Australia
| | - Alana Rix
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Janani Sivasuthan
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Claire J Tipping
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Peter Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Christina Whitehead
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Intensive Care Medicine Nepean Hospital, New South Wales, Australia
| | - Isabelle T Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shannah Anderson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy (Allied Health), The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, Victoria, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Fulcher BJ, Nicholson AJ, Linke NJ, Berkovic D, Hodgson CL, Anderson S, Bailey MJ, Bernard S, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Higgins AM, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Reddi BAJ, Stub D, Trapani T, Udy AA. The perceived barriers and facilitators to implementation of ECMO services in acute hospitals. Intensive Care Med 2020; 46:2115-2117. [DOI: 10.1007/s00134-020-06187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
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Linke NJ, Fulcher BJ, Engeler DM, Anderson S, Bailey MJ, Bernard S, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Higgins AM, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Sheldrake J, Reddi BAJ, Stub D, Trapani TV, Udy AA, Hodgson CL. A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units. CRIT CARE RESUSC 2020; 22:166-170. [PMID: 32389109 PMCID: PMC10692478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Daniel M Engeler
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | | | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Stephen Bernard
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Jasmin V Board
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Daniel Brodie
- Department of Medicine and Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA
| | - Heidi Buhr
- Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Aidan J C Burrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - David J Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Gattas
- Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Ingrid K Hopper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Sue Huckson
- Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Shay P McGuinness
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Orford
- Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia
| | - Rachael L Parke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | | | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Jayne Sheldrake
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Dion Stub
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Tony V Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
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Linke NJ, Fulcher BJ, Engeler DM, Anderson S, Bailey MJ, Bernard S, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Higgins AM, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Sheldrake J, Reddi BAJ, Stub D, Trapani TV, Udy AA, Hodgson CL. A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units. CRIT CARE RESUSC 2020. [DOI: 10.51893/2020.2.sur7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Australia, extracorporeal membrane oxygenation (ECMO) is one of the most expensive diagnosis-related groups, costing $305 463 per complex admission to the intensive care unit(ICU). Mortality in this group of patients is high, about 43% for respiratory failure and 68% for cardiac failure. ECMO is associated with significant risk to the patient and requires specialist training andexpertise. Variation in clinical practice for patients supported with ECMO may compromise patient care and outcomes.
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Mackle DM, Bailey MJ, Beasley RW, Bellomo R, Bennett VL, Deane AM, Eastwood GM, Finfer S, Freebairn RC, Litton E, Linke NJ, McArthur CJ, McGuinness SP, Panwar R, Young PJ. Protocol summary and statistical analysis plan for the intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX). CRIT CARE RESUSC 2018; 20:22-32. [PMID: 29458318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The balance of risks and benefits of conservative v standard care oxygen strategies for patients who are invasively ventilated in the intensive care unit (ICU) is uncertain. OBJECTIVE To describe the study protocol and statistical analysis plan for the ICU randomised trial comparing two approaches to oxygen therapy (ICU-ROX). DESIGN, SETTING AND PARTICIPANTS Protocol for a multicentre, randomised, participant and outcome assessor-blinded, standard care-controlled, parallel-group, two-sided superiority trial to be conducted in up to 22 ICUs in Australia and New Zealand. 1000 adults who are mechanically ventilated in the ICU and expected to remain ventilated beyond the day after recruitment will be randomly assigned to conservative oxygen therapy or standard care in a 1:1 ratio. ICU-ROX began with an internal pilot phase in September 2015. It is anticipated that recruitment will be completed in 2018. MAIN OUTCOME MEASURES The primary endpoint will be alive, ventilator-free days to Day 28. Secondary outcomes include 90- and 180-day all-cause mortality, survival time to 180 days, and quality of life and cognitive function at 180 days. All analyses will be conducted on an intentionto- treat basis. RESULTS AND CONCLUSIONS ICU-ROX will compare the effect of conservative v standard oxygen therapy in critically ill mechanically ventilated adults who are expected to be ventilated beyond the day after recruitment on ventilatorfree days to Day 28. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTRN 12615000957594).
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Affiliation(s)
- Diane M Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand.
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Victoria L Bennett
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Simon Finfer
- Intensive Care Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ross C Freebairn
- Intensive Care Unit, Hawke's Bay Hospital, Hastings, New Zealand
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Natalie J Linke
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Colin J McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, Newcastle, NSW, Australia
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
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Young PJ, Mackle DM, Bailey MJ, Beasley RW, Bennett VL, Deane AM, Eastwood GM, Finfer S, Freebairn RC, Litton E, Linke NJ, McArthur CJ, McGuinness SP, Panwar R, Bellomo R. Intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX): results of the pilot phase. CRIT CARE RESUSC 2017; 19:344-354. [PMID: 29202261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of the intensive care unit randomised trial comparing two approaches to oxygen therapy (ICU-ROX) pilot phase, which included the first 100 patients of an overall sample of 1000, was to examine feasibility. DESIGN Investigator-initiated, prospective, parallel-group, pilot randomised controlled trial. SETTING Six medical-surgical intensive care units (ICUs) in Australia and New Zealand, with participants recruited from September 2015 through June 2016. PARTICIPANTS 100 patients ≥ 18 years of age who required invasive mechanical ventilation in the ICU and were expected to be receiving it beyond the next calendar day at the time of randomisation. INTERVENTIONS Conservative oxygen therapy or standard care. MAIN OUTCOME MEASURES Eligibility, recruitment rate, and separation in oxygen exposure (fraction of inspired oxygen [FiO2] and oxygen saturation measured by pulse oximetry [SpO2Z]). RESULTS 94 of 99 participants (94.9%) were confirmed by study monitors to fulfil the study eligibility criteria. 3.6 patients per site per month were enrolled (95% confidence interval [CI], 2.5-4.7). Patients allocated to conservative oxygen therapy spent significantly more time on an FiO2 of 0.21 in the ICU; median, 31.5 hours (interquartile range [IQR], 7-63.5) for conservative oxygen therapy patients v 0 hours for standard oxygen therapy patients (IQR, 0-10; midpoint difference, 21.5 hours; 95% CI, 9-34; P < 0.0001). Patients allocated to conservative oxygen therapy spent less time in the ICU with an SpO2Z of ≥ 97% than patients allocated to standard oxygen therapy; median, 18.5 hours (IQR, 5-46) for conservative oxygen therapy patients v 32 hours for standard oxygen therapy (IQR, 17-80; midpoint difference, 13.5 hours; 95% CI, 2-25; P = 0.02). CONCLUSIONS Our findings confirm the feasibility of completing the ICU-ROX trial without the need for substantive changes to the study protocol for the remaining 900 trial participants. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ANZCTRN 12615000957594).
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Affiliation(s)
- Paul J Young
- Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
| | - Diane M Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Victoria L Bennett
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Simon Finfer
- Intensive Care Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ross C Freebairn
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia
| | - Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Colin J McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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