C4TS SPRING 2015 NEWSLETTER
Issue 6
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C4TS SPRING 2015 newsletter
WELCOME
Welcome to the Spring 2015 edition of the Barts Centre for Trauma Sciences (C4TS) Newsletter. We describe progress towards a Phase 2 clinical trial testing a drug that could protect organs in severely injured patients. We also discuss some of our research into trauma induced secondary cardiac injury and throw the spotlight on our efforts to improve the clinical database for EDs in England and Wales. We cover C4TS’s first mouthwatering bake -off to support Barts Charity’s new trauma appeal.
Professor Chris Thiemermman; Lead, Organ Failure and Protection theme
Trauma organ protection - Artesunate Thanks to a Wellcome Trust award of £780,000, C4TS are now seeking regulatory approval to conduct an exciting Phase 2a clinical trial of Artesunate for the protection of organs in severely injured patients with traumatic haemorrhage. Background
As discussed in the Autumn 2014 newsletter, multiple organ failure affects 1 in 3 severely injured patients and, if not fatal, results in worse outcomes such as prolonged critical care needs and poor long-term quality of life. Development of organ failure occurs early (within two days of admission) and correlates with an increase in hospital-acquired infections and if it persists, mortality. Currently there are no specific treatments for organ failure. A therapeutic agent that reduces the incidence and severity of multiple organ failure could have a major global impact on trauma patient outcomes and their demands for healthcare utilization.
By Professor Chris Thiemermman, Lead, Organ Failure and Protection Promising discovery of new use for an old drug
Artesunate is a drug that has been in use for many years as the treatment of choice for severe malaria. It has very few adverse effects and can even be used safely by patients with kidney failure or liver dysfunction. Using experimental (rat) models of severe bleeding, we have discovered that the intravenous injection of small doses of Artesunate (1 to 4.8 mg/kg) upon resuscitation reduces organ failure after trauma haemorrhage.
Figure 1: Artesunate molecular structure
The drug appears to be enhancing the protection of organs by reducing the body’s excessive response (i.e. inflammation) to injury and blood loss, and by activating well-known cell-survival pathways. Click here to find out more about other C4TS research projects.
Translating trauma research into trauma practice This trial of Trauma Organ Protection using Artesunate (TOP-ART) will:
Compare safety and benefit of Artesunate administration to standard treatment in severely injured bleeding trauma patients Be a single-centre study at the Royal London Hospital Major Trauma Centre Recruit 105 adult trauma patients o 35 low dose Artesunate, 35 high dose Artesunate, 35 low dose placebo Enrol eligible patients over 24 month period (starting summer 2015) Determine patient outcomes in hospital for up to 28 days and at 1 year post injury
C4TS SPRING 2015 NEWSLETTER | Issue 6
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Research Projects Spotlight Emergency Department Dataset Development in U.K By Graham Kirkwood, Public Health and Policy Research Fellow
England’s emergency departments (EDs) in crisis? The winter of 2014/15 in England was one of the mildest on record, but demand for emergency department care sky-rocketed. Why? Some blamed lack of GP out of hours care, others pointed to growing numbers of the frail and elderly. Major incidents were declared in several hospitals which in some cases led to locked doors barring entry even to paramedics. But our understanding of what caused this crisis has been significantly hampered by the lack of relevant data. The need to improve our A&E database The current A&E information base used by clinicians and funders (commissioning groups) in England and Wales is the Accident and Emergency Commissioning Dataset (CDS 010). Dr Tom Hughes, the chair of the Informatics Committee of the Royal College of Emergency Medicine (RCEM) described this database as “good at delivering the clinical care delivered 30 years ago”, but not equipped to deal with the care provided in today’s ED. To help fill this information vacuum, a RCEM sponsored project is underway to replace CDS 010 with an improved A&E dataset. The College of Emergency Medicine’s minimum dataset will provide better quality data on emergency care. It incorporates both the RCEM’s Unified Diagnostic Dataset, to improve the quality of recorded diagnosis, and the European standard Joint Action on Monitoring Injuries in Europe (JAMIE) minimum dataset for injuries.
Figure 2 Graham Kirkwood
Better A&E data is vital!
Better understand A&E demand Injuries estimated to be cause of a quarter of ED attendances – robust data will support injury prevention programs Payments to hospitals don’t reflect nature and volume of emergency care work – better data will enable better funding decisions
Professor Allyson Pollock, lead for C4TS’s Public Health and Policy research core, and myself will be part of the working groups developing the new dataset, which is due to be implemented within 18 months.
Trauma-Induced Secondary Cardiac Injury (TISCI)
Figure 3 Johanna Wall
By Johanna Wall
Previous research conducted at C4TS has identified a secondary cardiac injury, which may occur in patients after severe trauma. The development of Trauma Induced Secondary Cardiac Injury (TISCI) is not related to direct cardiac injury and can occur in people who have had no pre-existing history of heart disease. The pathophysiology of organ failure after trauma is complex. We need a better understanding of the mechanisms that are involved in the development of this cardiac injury, which leads to adverse cardiac events and poorer long-term outcomes for patients who have survived severe injury.
The heart is put under stress when the body experiences injury and significant blood loss. We have seen evidence of this with the release of heart-specific biomarkers from cardiomyocytes (cardiac muscle cells) into the bloodstream as early as an hour after injury. I aim to establish what the implications for heart function are by using specialised scanning techniques to look at heart structure and function during the crucial first hours after injury and haemorrhage. My C4TS research will help to identify mechanisms involved in the development of cardiac dysfunction after trauma in order to inform potential therapeutic strategies for our patients.
C4TS SPRING 2015 NEWSLETTER | Issue 6
GET INVOLVED!
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C4TS Exchange Program
Issue 6
By Julian-Dario Rembe
In March 2015, I left Cologne to join the trauma research team at the Royal London Hospital (RLH) as part of C4TS’s student/researchers TACTIC exchange program. TACTIC, which stands for Targeted Action for Curing Trauma Induced Coagulopathy, is a five year (2013-2018) program of comparative clinic research that is recruiting patients from a network of specialized trauma centres in Amsterdam, Cologne, Copenhagen, London, Oslo and Oxford to compare the effectiveness of different practices in trauma haemorrhage management across Europe The C4TS exchange program enables students/ researchers to work within the TACTIC network at different sites.
Figure 4 – Julian -Dario Rembe
One of the main goals of the trip was to identify any differences in procedures for recruiting patients and processing samples between Cologne and London, and suggest which site practices could be usefully adopted by the other. For example, the London site performs more sample analysis than Cologne, such as Multiplate® and TEG® to monitor a patient’s coagulation. Also, since the RLH is Europe’s busiest major trauma centre, the frequency of severely injured patients is higher than the Cologne-Merheim Medical Centre. This allowed me to observe a wide variety of traumatic injuries and their management.
News and events
Some of the moving trauma survivor stories on our new AfterTrauma website have been profiled in the London press Professor Allyson Pollock’s team examined rugby injury surveillance and protection programs from around the world and raised concerns about head and spinal injuries particularly in school sports. Her results were published in the British Medical Journal and received extensive media coverage A new trauma public engagement event targeting London’s East End community is being planned for late summer. More information in the next edition.
‘WHAT IS YOUR VISION?’
RESEARCHER QUOTES
“As a professor of public health, I’m particularly passionate about finding ways to prevent injuries and trauma happening in the first place especially in children and older people. I have special areas of interest which includes injuries sustained in sport such as rugby and cycling, concussion and head injury and effective prevention and rehabilitation policies. Prevention strategies need the support of social and political institutions. C4TS is a unique and important platform that brings together clinical scientists working on injury and trauma in many fields, allowing us to share our knowledge and expertise. My ambition is to persuade politicians to take injury seriously and to put in place proper systems for monitoring and effective prevention, and to invest in treatment and rehabilitation.”
You can contact C4TS via our website or @CommsC4TS. We’d love to hear from you!
The time with the RLH trauma research team provided me with new knowledge, skills and great experiences, as well as new ideas, research results, and reinforced my interest in trauma research as a career. I can highly recommend the C4TS exchange program!
New C4TS fundraising appeal launched
Figure 5 C4TSers demonstrate the science of baking
On Wednesday 1st April, some C4TS researchers became patissiers and held a trauma themed bake-off to raise funds for Barts Charity’s newly launched trauma appeal. A stall was held at our home in the Blizard Institute. While all medical research requires more funding, investment in traumatic injury research does not reflect the significant burden of disease and numbers of people affected across the globe. If you’d like to raise money for C4TS then please contact Simon from Barts Charity.