‘Golden Hour’ Study Reaches Major Trauma Milestone

More than 200 major trauma patients have been recruited for a pioneering £10 million research project looking at early detectors of probable susceptibility to in-hospital infection and / or multi-organ failure.

The ‘Golden Hour’ study, which commenced in 2014, is being led by Research in Emergency and Acute Care Team at the Queen Elizabeth Hospital in Birmingham and is supported by the National Institute of Health Research (NIHR). The study aims to improve patient outcomes by developing tests to help clinicians treating those who have suffered a major trauma to spot the early signs of whether patients are more likely to develop a serious infection or multi-organ failure in hospital in the days and week following the initial injury.

The research, which has now recruited more than half of the patients required, is being supported by the critical care paramedics and pre-hospital emergency medicine doctors at Midlands Air Ambulance Charity and West Midlands Ambulance Service University NHS Foundation Trust (WMAS), who collect blood samples from appropriate patients during the first hour of treatment.

Dr Jon Hazeldine, research fellow at the University of Birmingham, who is leading the study, explains the research: “Although the major and immediate cause of death following severe trauma is haemorrhage, many trauma victims later die following complications such as multi-organ dysfunction or sepsis, with the individual’s immune response to injury significantly influencing the chances of developing these life-threatening conditions.

“To investigate the immune response to major trauma the Golden Hour study analyses blood samples acquired from trauma patients at a number of post-injury time-points. The acquisition of these samples commences in the pre-hospital setting, where patients are enrolled into the study within 60-minutes of their injury, a crucial time in which prompt medical treatment is key to survival.

“Our collaboration with Midlands Air Ambulance Charity and WMAS provides us with unique access to trauma patient blood samples from the scene of injury, which enables us to study the immune system at the earliest possible opportunity following trauma. This has yielded new insights into the post-injury immune response and has demonstrated the importance of early blood sampling to truly understand how trauma alters the immune system.

“To date, we have recruited more than 200 patients into the study and our experiments have shown that within minutes of injury, the immune system of trauma patients is suppressed. Based on these initial findings, our next aim is to establish whether, in the immediate aftermath of a major injury, there are differences in the immune responses of patients who experience poor clinical outcomes (e.g. the development of sepsis or multi-organ failure) compared to those who do not. If this proves to be the case, then we would be one step closer to uncovering potential markers that could be used to aid in the early identification and stratification of patients at risk of poor outcomes, which could have implications for their management and treatment.”

Dr Mark Nash, medical director for Midlands Air Ambulance Charity, added: “The first hour of treatment post-incident is renowned for being the most beneficial, giving a patient the best possible chance of survival and good recovery. We were keen to support the Golden Hour study to assist with patients’ on-going advanced care within the hospital setting, again giving those in critical condition the best chance of a good outcome. The fact that more than 200 patients have now been recruited to the research will help the NIHR to positively influence in-hospital care, which will be of great benefit to patients.”

Dr Alex James, deputy clinical lead for the medical emergency response incident team (MERIT) for WMAS, said: “Our team see some of the most critically injured patients in the West Midlands. This collaboration with University of Birmingham, NIHR, University Hospitals Birmingham NHS Trust and Midlands Air Ambulance Charity has the potential to radically improve our understanding of trauma. In turn this could unlock benefits in assessment and treatment not just for patients here in the West Midlands, but around the world and is something we can all be immensely proud of.”

To find out more about the Golden Hour study, visit srmrc.nihr.ac.uk/trials/golden-hour. Further information on Midlands Air Ambulance Charity is found at midlandsairambulance.com and West Midlands Ambulance Service is found at wmas.nhs.uk

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