Blood-CRE: Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma
The Blood-CRE brings together a world-class team of investigators with the support of the key clinical specialties and blood sector stakeholders. It will evaluate current transfusion practice and lead an innovative program of research that will test novel approaches to blood management. The Blood-CRE will be a catalyst to the translation of findings to drive policy and practice; increase blood transfusion research capacity; enhance and expand collaboration; and improve patient outcomes.
Transfusion of blood products is one of the most common medical procedures in hospital patients. Despite common usage, there is considerable uncertainty about the relative risks and benefits of transfusions with a large and growing body of literature that questions the appropriateness of many common transfusion practices in terms of patient outcomes. In addition, current guidelines are based on inadequate evidence, and compliance with their recommendations is reputedly poor.
In 2012, the Federal Minister for Health announced $2.5 million in National Health and Medical Research Council (NHMRC) funding to establish the Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma at Monash University-the Blood-CRE. The Blood-CRE, led by Intensive Care physician Professor Jamie Cooper (pictured right) of the University's Department of Epidemiology and Preventive Medicine (DEPM), represents a consortia of national research and key organisations responsible for the regulation, manufacture, supply and surveillance of blood products including the Australian Red Cross Blood Service, National Blood Authority, Transfusion Outcomes Research Collaborative (TORC), Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Australian Defence Force, Australian and New Zealand Society for Blood Transfusion, and the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resource Evaluation (ANZICS-CORE).
The Blood-CRE will coordinate a research strategy that will evaluate current clinical practice through existing and extended clinical registries, conduct preliminary observational research and large multicentre randomised controlled trials (RCTs), and direct and evaluate the translation of evidence into policy and practice. The Blood-CRE research strategy diagram (pictured below) describes the key research foci and their interactions within the Centre: clinical registries; prospective clinical research; and practice, policy and stewardship. The Blood-CRE investigators strongly believe that the research strategy will improve patient outcomes and reduce costs for transfusion services.
This will be achieved by:
1. Understanding current transfusion practice through expansion of the Australasian Massive Transfusion Registry to all major acute care hospitals. Valuable information will also be generated by expanding the TORC Data Linkage program to include linkage to the ANZICS-CORE database, Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) cardiac surgery database, trauma registries throughout the country, and the National Death Index (NDI). This expansion will take advantage of the DEPM's long and successful history of registry development.
2. Optimising stewardship of donor blood and cost effectiveness of transfusion by studying the effects of duration and methods of blood storage in critical illness and trauma, and by conducting cost-effectiveness analyses. The recently commenced TRANSFUSE-RCT testing the hypothesis that, for critically ill patients who require transfusion, administration of freshest available red blood cells (RBCs), compared with standard inventory management, will improve survival is an exciting first step in the research strategy. Blood component storage methodology will also be examined by University of Queensland researchers and the Australian Defence Force who are about to commence a pilot trial of the administration of frozen platelets in bleeding cardiac surgery patients.
3. Minimising transfusion requirements in critical illness and trauma by studying the effects of interventions to minimise transfusion requirements in critical illness and trauma. NHMRC funding has been awarded to Monash University to commence a RCT comparing pre-hospital administration of tranexamic acid to standard management in bleeding trauma patients. In addition, the Western Australian government has funded a pilot trial examining the impact of the administration of IV iron in critically ill patients on blood transfusion requirements and clinical outcomes.
The Blood-CRE provides a solution to the critical problem of an unmet need with regard to the transfusion evidence-practice base. It provides a pathway by which the implementation of Patient Blood Management Guidelines can be optimised and monitored, and the transfusion evidence base improved. Transfusion policy will also be informed by knowledge generated by the Blood-CRE. This will assist in optimising transfusion practices to ensure demand does not outpace supply and that the outcomes of critically ill patients, for whom blood transfusion is vital for survival, are not compromised. In addition, it will develop greater research capacity in the fields of transfusion, critical care and military medicine by extending established networks of current collaborators and creating new research partnerships that will maximise our ability to effect change in transfusion practice and improve patient outcomes.
For further information: please contact Lynne Murray (pictured right), Blood-CRE Research Centre Manager, by email.