Evaluating the effectiveness of pre-hospital fibrinogen concentrate administration for major haemorrhage

Fibrinogen is a component of blood that is vital in the formation of blood clots, and low levels are often found in trauma patients who are bleeding. Low levels of fibrinogen cause problems with blood clotting and result in ongoing bleeding. Replacement fibrinogen has only been available in major hospitals which has been a problem given that the majority of trauma patients (most from the result of road accidents) treated by pre-hospital medical services are in rural and remote areas where this has not been available. Fibrinogen concentrate (FibC) is being introduced into Queensland’s pre-hospital and retrieval services to improve equity of access and facilitate early administration to patients that are critically bleeding. This study aims to evaluate the effectiveness of early FibC administration for bleeding trauma patients in the pre-hospital and retrieval setting and is the first study of its kind to do so. Should the study find a significant benefit of this early administration it will result in improved outcomes for such trauma patients, and has the potential to modify international medical practice in the management of bleeding trauma patients.

Improving blood culture collections in the emergency department

The primary aim of this study is to assess the effectiveness of an intervention designed to improve the quality of blood cultures collected in a busy emergency department.

Blood cultures are tests that are frequently ordered by emergency doctors to detect and identify bacteria present in the blood of patients who are unwell. The test requires a sample of blood to be collected from the patient. Like many tests, the quality of the results is related to the quality of the sample collection process.

Several factors may influence the quality of sample collection and increase the chance of sample contamination. These include not collecting enough blood and poor sterility of the collection process. Contamination of blood cultures may result in the patient staying longer in hospital, being prescribed unnecessary antibiotics and increasing the costs of care.

This study will implement a rigorous intervention to reduce contamination rates in blood culture samples collected at the Emergency and Trauma Centre at the Royal Brisbane and Women’s Hospital. The intervention comprises: education to staff that collect blood cultures; the introduction of blood culture collection kits; and regular feedback of quality indicators to the clinicians that collect blood cultures.

If successful, a reduction in blood culture contamination rates and single sets of cultures should be seen, and the average volume of blood cultured should increase. These outcomes may help to reduce patient length of stay, cost of care, with positive effects in anti-microbial stewardship and patient flow.

Accelerated pathway in the assessment of suspected acute coronary syndrome in the Emergency Department: a diagnostic accuracy study.

Chest pain is one of the most common conditions treated in the Emergency Department (ED), but making a diagnosis remains challenging and resource-intensive. Not all causes of chest pain are due to heart disease. Currently, doctors do a blood test to look for the presence of a cardiac chemical called Troponin I to assist them in making a diagnosis of heart disease. This chemical is released from heart muscles when they are damaged and is, therefore, a good indicator of heart attack. However, because Troponin I is released slowly, doctors have to wait for up to six hours to determine whether it is present in the blood.

This project hopes to make a more rapid diagnosis of the patient’s chest pain by measuring several different heart hormones and chemicals two hours after an individual presents to the ED. These chemicals are known as creatine kinase-MB-isoenzyme (CK-MB), B-type natruiretic peptide (BNP), and myoglobin.

This project will recruit 1000 consecutive patients presenting to the Royal Brisbane Emergency Department with greater than 5 minutes chest pain. Patients will be managed and investigated as per standard care. However, additional blood test will be taken at two hours to assess the combination of heart chemicals. Later there will be follow-up on patients to determine whether the two hour test was accurate in diagnosing heart attack.

Examination of health care assessment practices and costs pre- and post- implementation of an accelerated chest pain assessment protocol.

Professor Cullen and her research team developed the IMPACT protocol with EMF funding. This protocol enables the rapid diagnosis of low and medium risk patients presenting to the emergency department with chest pain. The protocol has been put into practice across Queensland Health. This body of research aimed to identify whether the translation had been successful at the Royal Brisbane and Women's Hospital.

Serum catecholamine levels in Irukandji Syndrome (IS)

Irukandji Syndrome (IS) is a condition caused by the venom of jellyfish found in the tropical waters of Australia and has received significant media attention over the past decade. The syndrome most commonly presents with a variable combination of severe generalised pain, involving the torso and limbs, nausea and vomiting, sweating, headache and severely elevated blood pressure and pulse. Documented complications of IS include myocardial (heart) damage and failure, intracerebral haemorrhage (bleeding on the brain) and death.

The signs and symptoms of IS are believed to be due to excessive release of endogenous catecholamines (stress hormones). A number of in-vitro and animal studies have documented elevated adrenaline and noradrenaline levels after exposure to venom from Carukia barnesi and related jellyfish. To date, no human trials have measured serum catecholamines in patients with suspected IS.

This elevation in serum catecholamines may account for the profoundly elevated blood pressure and heart rate seen with IS. However, it is unclear what association the severe generalised pain of IS has with elevation of the endogenous catecholamines, i.e. cause or effect. The research team will conduct a prospective, observational, case-control study on patients with IS at The Townsville Hospital to measure serum levels of noradrenaline and adrenaline.