An ICU for all Victorians

More critically ill and injured patients are being cared for - and more lives saved - in The Alfred’s 45-bed intensive care unit than ever before as the hospital marks 10 years since the modern facility opened its doors.

ICU director, A/Prof Steve McGloughlin said The Alfred is the only hospital in Victoria to have an ICU specialist on-site 24 hours a day, seven days a week.

“We want our patients to have the same care they would receive at 2am on a Sunday as they would mid-morning on a Wednesday," A/Prof McGloughlin said.

Home to statewide services including major trauma, heart and lung transplantation, burns and hyperbaric medicine, The Alfred’s ICU is for all Victorians – with patients from across the State and beyond arriving via air and road for this specialist care. 

“Our specialist care has enabled our staff to develop skills in certain areas and save patients that in the past may not have made it."

Since The Alfred ICU was expanded and redeveloped, numbers have increased significantly. Around 2,800 complex and critically unwell people were admitted in the last year - around 1000 more than a decade ago.

The unit runs at capacity on most days of the year, meaning on any given day, there are 45 patients, and their loved ones, whose lives have suddenly changed.

Assistant nurse unit manager, Padraig Keogh, has worked in the ICU for nine years and says even though the job is challenging, he enjoys working with a passionate team.

“We look after very sick people - and their family members - who find themselves in very difficult circumstances. It’s a privilege to be part of that journey,” Mr Keogh said.

Since the $25 million redevelopment and expansion, more than 24,000 of the State’s sickest patients have received leading care following car accidents, falls, assaults, burns or those battling acute illness.

Funding for the 2008-completed redevelopment and expansion came from the Victorian Government ($20.2 million), as well as philanthropic support from many individuals and organisations including a significant donation from Lindsay and Paula Fox and family.  The dedicated Fox Family Trauma Wing in the unit was named in recognition of their gift.

Brain cooling 'ineffective'

A therapy that has been used to treat patients with traumatic brain injury (TBI) for more than two decades is ‘strikingly ineffective’, according to a study by The Alfred intensive care specialist Professor Jamie Cooper.

Professor Cooper has challenged the global practice of inducing hypothermia in patients who have sustained a TBI, and found it has no neurological benefit for patients in the long term. The paper, which was published in the Journal of the American Medical Association earlier this year, has already influenced change in clinical practice.

"This common therapy is expensive, labour and ICU intensive – yet it is strikingly ineffective," Professor Cooper said.

It was previously believed that cooling patients to an internal body temperature of 33°C-35°C for at least three days, followed by gradual re-warming, led to decreased mortality rates and improved neurological outcomes. However, Professor Cooper’s study has found this is not the case.

“This common therapy is expensive, labour and ICU intensive, and has been researched and used clinically for more than two decades globally – yet it is strikingly ineffective, and has unambiguous complications,” Professor Cooper said.

“We have stopped using it at The Alfred ICU for these patients.”

The Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients with Severe Traumatic Brain Injury (POLAR) study ran internationally between December 2010 and November 2017, and enrolled 511 randomised patients. 

'His heart was barely functioning'

Years of perfecting an advanced form of life support for critically ill patients in the intensive care unit has saved the life of a Melbourne man who was admitted for a complex heart procedure.

While the technique, known as ECMO, can be used to sustain the lives of patients experiencing organ failure over days, weeks or even months, the advanced form of mechanical blood pressure support – which temporarily fulfils the role of a patient’s heart and lungs – is rarely applied as a failsafe during a coronary stent procedure.

Alfred cardiologist, A/Prof Tony Walton said his patient’s heart was so badly damaged from prior heart attacks that the team felt he would not survive the procedure he desperately needed. 

“Elsewhere, he would have likely ended up on life support, and then urgently transferred to a major hospital like ours, with a view to implanting an artificial heart, and maybe waitlisted for a transplant,” A/Prof Walton said.

“We needed to proceed with the coronary stenting, and the only option was to attempt it while he was on ECMO in the cath lab.  Most hospitals just aren’t setup for this high-end level of support.

“The case went spectacularly well because we have a fantastic intensive care ECMO team and, together, we were able to bridge our patient through the procedure. 

We repaired his heart and three days later he went home.”

Head of The Alfred’s ECMO program and intensive care specialist, Dr Vincent Pellegrino, said his team regularly manages multiple patients using this advanced form of life support on any given day.  Later this month, the unit is likely to surpass 100 ECMO patients in one year for the first time.

“We have worked hard to advance our program over many years, and the cath lab setting presented a terrific opportunity to help this man, and increase the scope of the service for the intensive care and cardiology teams,” Dr Pellegrino said.

“The application of advanced life support for patients requiring high-risk invasive procedures hasn’t been our prior focus, but it’s an area that is likely to grow and save more lives.”

ECMO stands for extracorporeal membrane oxygenation. It is used to provide prolonged heart and lung support to persons whose organs are not functioning adequately enough to sustain life.