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Aim: To describe the first Australian cases of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2) disease (COVID‐19) pneumonia treated with the interleukin‐6 receptor antagonist tocilizumab. Methods: Retrospective, open‐label, real‐world, uncontrolled, single‐arm case series conducted in 2 tertiary hospitals in NSW, Australia and 1 tertiary hospital in Victoria, Australia. Five adult male patients aged between 46 and 74 years with type 1 respiratory failure due to COVID‐19 pneumonia requiring intensive care unit (ICU) admission and biochemical evidence of systemic hyperinflammation (C‐reactive protein greater than 100 mg/L; ferritin greater than 700 μg/L) were administered variable‐dose tocilizumab. Results: At between 13 and 26 days follow‐up, all patients are alive and have been discharged from ICU. Two patients have been discharged home. Two patients avoided endotracheal intubation. Oxygen therapy has been ceased in three patients. Four adverse events potentially associated with tocilizumab therapy occurred in three patients: ventilator‐associated pneumonia, bacteremia associated with central venous catheterization, myositis and hepatitis. All patients received broad‐spectrum antibiotics, 4 received corticosteroids and 2 received both lopinavir/ritonavir and hydroxychloroquine. The time from first tocilizumab administration to improvement in ventilation, defined as a 25% reduction in fraction of inspired oxygen required to maintain peripheral oxygen saturation greater than 92%, ranged from 7 hours to 4.6 days. Conclusions: Tocilizumab use was associated with favorable clinical outcome in our patients. We recommend tocilizumab be included in randomized controlled trials of treatment for patients with severe COVID‐19 pneumonia, and be considered for compassionate use in such patients pending the results of these trials. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine if intubation using larger endotracheal tube sizes in mechanically ventilated patients with thermal burn injury adversely affects voice and swallowing function. This prospective, observational study was conducted in patients with thermal burn injuries, who were mechanically ventilated via an endotracheal tube. The primary outcome measures were changes in voice and swallowing function, assessed using the Australian Therapy Outcome Measures (AusTOMS), immediately before the burn injury, and 12 months after the removal of the endotracheal tube. Of 101 patients screened, 20 male patients were followed for 12 months. Patients intubated with size 8.0 or larger endotracheal tubes were compared to patients with size 7.5 endotracheal tubes or smaller. Patients with the larger endotracheal tubes had a significant 1.8-point (9%) decline in their AusTOMS voice score (p =.01) using the paired t-test, but there was no significant difference between the two groups using the independent samples t-test. There was no significant difference in swallowing outcome between the two groups. Male patients with thermal burn injuries, mechanically ventilated using size 8.0 endotracheal tubes or larger, had a statistically significant decline in voice outcome; however, interpretation of this result is limited by methodological considerations. [ABSTRACT FROM AUTHOR]

The article focuses on a study which analyzed the increase in intensive care unit (ICU) bed availability resulting from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols. The study included eight Australian, adult, general ICU patients and was conducted between September 2009 and May 2010. Study authors concluded that triage protocols resulted in increased ICU bed availability.

Objective: To determine the rate of adverse events and incidents occurring as a result of hospital staff leaving normal duties to attend medical emergency team (MET) calls., Design, Participants and Setting: Single-centre, interview and questionnaire-based study of staff attending MET calls at a 650-bed university teaching hospital in Sydney, New South Wales, July to December 2013., Main Outcome Measure: The rate of adverse events and incidents directly related to MET staff leaving normal duties to attend MET calls., Results: During the study period, 1490 structured interviews were conducted, and 279 written questionnaires were returned (overall response rate, 66.4%). There were no adverse events. There were 378 recorded incidents. The incident rate was 213.7 incidents per 1000 MET participant attendances (95% CI, 194.8-233.5), and 1.1 incidents per MET call. Using the severity assessment code, 99.5% of incidents were classified as minimum. The most commonly reported incidents were disruptions to normal duties, ward rounds, and patient reviews. Only 0.8% of incidents were reported on institutional incident reporting systems., Conclusion: Significant disruption to normal hospital routines and inconvenience to staff occurred, without causing major harm to patients, when MET staff temporarily left normal duties to attend MET calls. Normal hospital incident reporting systems cannot be used to monitor for these problems, as they are underreported.

Objective: To determine whether survival following out-of- hospital cardiac arrest (OHCA) in Sydney, Australia, improved between 2004-2005 and 2009-2010, and whether there was a change in incidence of OHCA., Design: Retrospective study using the Ambulance Service of New South Wales and NSW Registry of Births, Deaths and Marriages databases., Participants and Setting: All patients who had an OHCA in the Sydney metropolitan area and who used the Ambulance Service of NSW between June 2009 and May 2010 (2009-2010), and between June 2004 and May 2005 (2004-2005)., Main Outcome Measures: Survival to 90 days. Other outcome measures included the incidence of OHCA and survival to the day following OHCA, 28 days and 1 year following OHCA. Survival and incidence were also calculated according to initial electrocardiograph rhythm., Results: Survival to 90 days was 12.3% in 2004-2005 and 10.2% in 2009-2010 (P = 0.015). In 2004-2005, the age standardised incidence of OHCA was 52.6 events per 100 000 person-years (95% CI, 51.6-53.6 events per 100 000 person-years), and in 2009-2010 it was 48.4 events per 100 000 person-years (95% CI, 46.3-50.4 events per 100 000 person-years). In 2004-2005, the incidence of ventricular fibrillation (VF) was 31.3% (95% CI, 28.4%- 33.9%) and in 2009-2010 it was 22.1% (95% CI, 20.0%- 24.3%)., Conclusion: There was no improvement in survival following OHCA in Sydney between 2004-2005 and 2009- 2010. There has been a decrease in overall survival from OHCA and a decrease in the overall age-standardised incidence of OHCA. The decrease in overall survival may be due to a decline in the incidence of VF.

Objectives: To develop an influenza pandemic ICU triage (iPIT) protocol that excludes patients with the highest and lowest predicted mortality rates, and to determine the increase in ICU bed availability that would result., Design and Setting: Post-hoc analysis of a study evaluating two triage protocols, designed to determine which patients should be excluded from access to ICU resources during an influenza pandemic. ICU mortality rates were determined for the individual triage criteria in the protocols and included criteria based on the Sequential Organ Failure Assessment (SOFA) score. Criteria resulting in mortality rates outside the 25th and 75th percentiles were used as exclusion criteria in a new iPIT-1 protocol. The SOFA threshold component was modified further and reported as iPIT-2 and iPIT-3., Main Outcome Measure: Increase in ICU bed availability., Results: The 25th and 75th percentiles for ICU mortality were 8.3% and 35.2%, respectively. Applying the iPIT-1 protocol resulted in an increase in ICU bed availability at admission of 71.7% ± 0.6%. Decreasing the lower SOFA score exclusion criteria to ≤6 (iPIT-2) and ≤4 (iPIT-3) resulted in an increase in ICU bed availability at admission of 66.9% ± 0.6% and 59.4 ± 0.7%, respectively (P < 0.001)., Conclusion: The iPIT protocol excludes patients with the lowest and highest ICU mortality, and provides increases in ICU bed availability. Adjusting the lower SOFA score exclusion limit provides a method of escalation or de- escalation to cope with demand.

Background: Out-of-hospital cardiac arrest (OHCA) is a significant cause of death, but there is little published information on its incidence and outcomes in Australia., Aim: This study was undertaken to determine the incidence and survival from OHCA in Sydney, New South Wales., Methods: Patients listed on the Ambulance Service of NSW database as having an OHCA during the 12-month period 1 June 2004 to 31 May 2005 were matched with the NSW Registry of Births, Deaths and Marriages to determine if they had died, and how long they survived. Survival was also determined for patients aged 80 years or older, and for the presenting electrocardiograph (ECG) rhythm., Results: OHCAs were recorded for 2011 people in a population of 3.993 million. The age-standardised incidence was 52.6 events per 100,000 person-years (95% CI, 51.6-53.6). Incidence was significantly higher in older age groups. Only 24% of patients survived past the day of the OHCA. Survival for 28 days, 90 days and 1 year was 12.6%, 12.2%, and 11.5%, respectively. Survival was highest when the presentation ECG was ventricular fibrillation. Patients aged 80 years or older had lower survival rates., Conclusion: Survival from OHCA in Sydney is low, and lower in patients aged 80 years or older. The incidence of OHCA in Sydney is similar to that in the rest of the world. Mortality occurs early after OHCA. Hence, for interventions to be effective in improving survival, they need to be targeted at the early stages of OHCA.