Publications by authors named "Tony Trapani"

Objective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.

Design Setting And Participants: This is a registry-embedded observational cohort study.

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  • The study explored the effects of conservative versus liberal oxygen strategies on patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the ICU, aiming to find a balance between avoiding hyperoxia and preventing hypoxia.
  • A total of 300 patients were randomly assigned to either conservative (target SaO 92-96%) or liberal oxygen (target SaO 97-100%), but both groups showed similar outcomes in ICU-free days and mortality rates at days 28 and 60.
  • The conservative group had significantly more major protocol deviations compared to the liberal group, but overall, the two oxygen strategies did not differ in their impact on patient recovery in the ICU.
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  • The text indicates that there is a correction to a previously published article.
  • The article is identified by its Digital Object Identifier (DOI): 10.1016/j.ccrj.2023.06.001.
  • The correction aims to address inaccuracies or mistakes in the original publication.
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  • The TAME trial is a phase 3 clinical study investigating the effects of targeted therapeutic mild hypercapnia on brain injury in comatose adults revived from out-of-hospital cardiac arrest.
  • It involves randomly assigning 1700 participants in various countries to either receive mild hypercapnia or maintain normal levels of carbon dioxide in their blood for 24 hours after resuscitation.
  • The main goal is to measure and compare the participants' functional outcomes at 6 months using the Glasgow Outcome Scale-Extended, alongside evaluating mortality, cognitive function, and quality of life as secondary outcomes.
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To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020.

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Importance: The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.

Objective: To determine whether vitamin C improves outcomes for patients with COVID-19.

Design, Setting, And Participants: Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents.

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Introduction: Critically ill patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) are at risk of developing severe arterial hyperoxia, which has been associated with increased mortality. Lower saturation targets in this population may lead to deleterious episodes of severe hypoxia. This manuscript describes the protocol and statistical analysis plan for the Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial.

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  • The LOGICAL trial aims to compare the effects of conservative versus liberal oxygen therapy on ICU patients with suspected hypoxic ischaemic encephalopathy (HIE) after cardiac arrest.
  • Involving 1400 comatose adults, this randomised clinical trial will measure outcomes like survival with good neurological function using the Extended Glasgow Outcome Scale at 180 days.
  • The results will help clarify the optimal oxygen therapy approach for these patients and have the potential to improve clinical practices in critical care settings.
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Purpose: Recombinant erythropoietin (EPO) administered for traumatic brain injury (TBI) may increase short-term survival, but the long-term effect is unknown.

Methods: We conducted a pre-planned long-term follow-up of patients in the multicentre erythropoietin in TBI trial (2010-2015). We invited survivors to follow-up and evaluated survival and functional outcome with the Glasgow Outcome Scale-Extended (GOSE) (categories 5-8 = good outcome), and secondly, with good outcome determined relative to baseline function (sliding scale).

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  • Guidelines suggest maintaining normal carbon dioxide levels for adults in a coma resuscitated from cardiac arrest, but mild higher levels may help increase brain blood flow and improve outcomes.
  • In a study involving 1,700 patients, participants were randomly assigned to either mild hypercapnia or normocapnia for 24 hours and were assessed 6 months later for neurologic recovery.
  • Results showed no significant difference in favorable neurological outcomes or mortality between the two groups, indicating that mild hypercapnia did not improve recovery compared to normal levels.
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Background: Whether prehospital administration of tranexamic acid increases the likelihood of survival with a favorable functional outcome among patients with major trauma and suspected trauma-induced coagulopathy who are being treated in advanced trauma systems is uncertain.

Methods: We randomly assigned adults with major trauma who were at risk for trauma-induced coagulopathy to receive tranexamic acid (administered intravenously as a bolus dose of 1 g before hospital admission, followed by a 1-g infusion over a period of 8 hours after arrival at the hospital) or matched placebo. The primary outcome was survival with a favorable functional outcome at 6 months after injury, as assessed with the use of the Glasgow Outcome Scale-Extended (GOS-E).

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Objective(s): To use machine learning (ML) to predict short-term requirements for invasive ventilation in patients with COVID-19 admitted to Australian intensive care units (ICUs).

Design: A machine learning study within a national ICU COVID-19 registry in Australia.

Participants: Adult patients who were spontaneously breathing and admitted to participating ICUs with laboratory-confirmed COVID-19 from 20 February 2020 to 7 March 2021.

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  • ECMO (extracorporeal membrane oxygenation) is a life-supporting procedure for critically ill patients with severe cardiac or respiratory failure, but its long-term effects on survival and disability are still unclear.
  • A study conducted in Australia involved 391 patients who underwent ECMO, assessing their outcomes related to death or moderate-to-severe disability 6 months post-treatment.
  • Results showed that 66% of patients experienced death or disability, with higher rates in those who received extracorporeal cardiopulmonary resuscitation (eCPR) compared to veno-venous ECMO (VV-ECMO), indicating the need for careful consideration of treatment methods.
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Background: Vaccination has been shown to be highly effective in preventing death and severe disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Currently, few studies have directly compared vaccinated and unvaccinated patients with severe COVID-19 in the intensive care unit (ICU).

Aims: To compare the clinical characteristics and outcomes of vaccine recipients and unvaccinated patients with SARS-CoV-2 infection admitted to the ICU in a nationwide setting.

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  • Diabetes mellitus is a significant risk factor for severe COVID-19, but its effects on the Australian population had not been thoroughly investigated prior to this study.
  • The study analyzed 136 ICU patients in Melbourne with COVID-19, finding that 43% had diabetes, and noted that those with diabetes experienced worse outcomes, including longer hospital stays and higher mortality rates.
  • The findings underscore the importance of targeted prevention strategies for diabetes management in patients hospitalized with severe COVID-19 in Australia.
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Objective: To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID-19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia.

Design, Setting, And Participants: People aged 16 years or more admitted with polymerase chain reaction-confirmed COVID-19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia project during the first (27 February - 30 June 2020), second (1 July 2020 - 25 June 2021), and third COVID-19 waves (26 June - 1 November 2021).

Main Outcome Measures: Primary outcome: in-hospital mortality.

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Monitoring and optimisation of brain tissue oxygen tension (PbtO) has been associated with improved neurological outcome and survival in observational studies of severe traumatic brain injury (TBI). We carried out a systematic review of randomized controlled trials to determine if PbtO-guided management is associated with differential neurological outcomes, survival, and adverse events. Searches were carried out to 10 February 2022 in Medline (OvidSP), 11 February in EMBASE (OvidSP) and 8 February in Cochrane library.

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Purpose: To determine the frequency of nosocomial infections including hospital-acquired pneumonia (HAP) and bloodstream infection (BSI), amongst critically ill patients with COVID-19 infection in Australian ICUs and to evaluate associations with mortality and length of stay (LOS).

Methods: The effect of nosocomial infections on hospital mortality was evaluated using hierarchical logistic regression models to adjust for illness severity and mechanical ventilation.

Results: There were 490 patients admitted to 55 ICUs during the study period.

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The outcomes of survivors of critical illness due to coronavirus disease (COVID-19) compared with non-COVID-19 are yet to be established. 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. We included critically ill patients with COVID-19 and non-COVID-19 from two prospective observational studies.

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To expand our understanding of the role of angiotensin II (ANGII) in coronavirus infectious disease 2019 (COVID-19), we conducted an international, multicenter registry study to assess the use of ANGII in patients with COVID-19 compared to patients not receiving ANGII. Critically ill adult patients who were diagnosed with COVID-19 and received ANGII were matched with COVID-19 patients not receiving ANGII according to age, respiratory support, history of hypertension, use of angiotensin-converting enzyme inhibitors and/or ANGII receptor blocker, and date of admission. All outcomes were exploratory in nature and included improvement in oxygenation, duration of organ support, and mortality.

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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.

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Objective: The aim of this manuscript is to compare characteristics, management, and outcomes of patients with severe Traumatic Brain Injury (TBI) between Australia, the United Kingdom (UK) and Europe.

Methods: We enrolled patients with severe TBI in Victoria, Australia (OzENTER-TBI), in the UK and Europe (CENTER-TBI) from 2015 to 2017. Main outcome measures were mortality and unfavourable outcome (Glasgow Outcome Scale Extended <5) 6 months after injury.

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Introduction: Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ineffective or harmful.

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Both 2009 pandemic influenza A (H1N1) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are transmitted by respiratory secretions and in severe cases result in a viral pneumonitis, requiring intensive care unit (ICU) admission. However, no studies have compared the clinical characteristics and outcomes of such patients. To report and compare the demographic characteristics, treatments, use of critical care resources, and outcomes of patients admitted to an Australian ICU with H1N1 influenza during the winter of 2009, and SARS-CoV-2 during the winter of 2020.

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