ORCID Profile
0000-0002-8977-9430
Current Organisations
St Vincent's Hospital
,
University of Sydney
,
London School of Hygiene and Tropical Medicine
,
The University of Notre Dame Australia - Sydney Campus Broadway
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Publications
Lung ultrasound score as an indicator of dynamic lung compliance during veno-venous extra-corporeal membrane oxygenation
Publisher: SAGE Publications
Date: 11-08-2021
Abstract: Decisions on weaning from veno-venous extra-corporeal membrane oxygenation (VV-ECMO) requires the ability to maintain adequate gas exchange and work of breathing with reductions in ECMO pump flow and fresh gas flow. Testing of the readiness to wean the patient from ECMO however may vary dependent upon local protocols and clinical judgment. This study sought to validate the use of the LUS-score during VV-ECMO against the changes in chest x-ray infiltrates, dynamic lung compliance (CLdyn) and VV-ECMO settings (as standard measures of native lung function and the level of ECMO support) during the ECMO cycle. This prospective cohort study of 10 patients on VV-ECMO compared the LUS score (range 0–36) within 48-h, day 5 and day 10 of commencement of ECMO (or on the day of ECMO decannulation) to dynamic lung compliance, Murray Lung Injury Score and ECMO settings. Seven Male and three Female patients were included (average age 37 years (SD 14.8) and weight 71 Kg (SD 16.9). Median (IQR) duration of ECMO, ICU and hospital length of stay was 7.5 days (5.2–19.0), 12.5 days (8.5–22.7), 19.0 days (12.1– 36.1), respectively. There was a strong negative association between LUS-score and dynamic lung compliance (r s (33) = –0.66, p .001) providing some validation on the use of the LUS score as a potential surrogate measure of lung aeration and lung mechanics during VV-ECMO weaning.
Cost effectiveness and quality of life analysis of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.RESUSCITATION.2019.03.021
Abstract: The use of extracorporeal membrane oxygenation (ECMO) in refractory cardiac arrest (ECPR) has increased exponentially. ECPR is a resource intensive service and its cost effectiveness has yet to be demonstrated. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes. We sought to complete a cost analysis with modelling of cost effectiveness and quality of life outcomes of patients who have undergone ECPR. Using data on all extracorporeal cardiopulmonary resuscitation (ECPR) patients at two ECMO centres in Sydney, Australia we completed a costing analysis of ECPR patients. A Markov model of cost, quality of life and survival outcomes was developed to examine cost per QALY estimates and incremental cost effectiveness ratios (ICERs). Probabilistic sensitivity analysis (PSA) was completed to assess the probability of cost effectiveness for base case and variations. Sixty-two consecutive ECPR patients were analysed mean age of 51.9 ± 13.6 years, 38 (61%) were in hospital cardiac arrests (IHCA). Twenty-five patients (40%) survived to hospital discharge all with a cerebral performance category (CPC) of 1 or 2. The mean cost per ECPR patient was AUD 75,165 (€50,535 ±AUD 75,737). Over 10 years ECPR was estimated to add a mean gain of 3.0 Quality Adjusted Life Years (QALYs) per patient with an incremental cost effectiveness ratio (ICER) of AUD 25,212 (€16,890) per QALY, increasing to 4.0 QALYs and an ICER of AUD 18,829 (€12,614) over a 15-year survival scenario. Mean cost per QALY did not differ significantly by OHCA or IHCA. ECMO support for refractory cardiac arrests is cost effective and compares favourably to accepted cost effectiveness thresholds.
In situ simulation improves ECPR survival – A ten Year Experience
Publisher: SAGE Publications
Date: 04-2019
The effect of a structured ECPR protocol aided by specific simulation training in a quaternary ECMO centre: A retrospective pre-post study
Publisher: Elsevier BV
Date: 06-2022
Incidence of early diaphragmatic dysfunction after lung transplantation: results of a prospective observational study.
Publisher: Wiley
Date: 08-07-2021
DOI: 10.1111/CTR.14409
Abstract: Diaphragmatic dysfunction is common after cardiothoracic surgery, but few studies report its incidence and consequences after lung transplantation. We aimed to estimate the incidence of diaphragmatic dysfunction using ultrasound in lung transplant patients up to 3 months postoperatively and evaluated the impact on clinical outcomes. This was a single‐center prospective observational cohort study of 27 lung transplant recipients using diaphragmatic ultrasound preoperatively, at 1 day, 1 week, 1 month, and 3 months postoperatively. Diaphragmatic dysfunction was defined as excursion 10 mm in men and 9 mm in women during quiet breathing. Clinical outcomes measured included duration of mechanical ventilation, length of stay (LOS) in Intensive Care (ICU), and hospital LOS. Sixty‐two percentage of recipients experienced new, postoperative diaphragmatic dysfunction, but the prevalence fell to 22% at 3 months. No differences in clinical outcomes were found between those with diaphragmatic dysfunction compared to those without. Patients who experienced diaphragmatic dysfunction at 1 day postoperatively were younger and had a lower BMI than those who did not. Diaphragmatic dysfunction is common after lung transplant, improves significantly within 3 months, and did not impact negatively on duration of mechanical ventilation, LOS in ICU or hospital, or discharge destination.
Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest: A multicentre experience
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.IJCARD.2016.12.003
Abstract: To describe the ECPR experience of two Australian ECMO centres, with regards to survival and neurological outcome, their predictors and complications. Retrospective observational study of prospectively collected data on all patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) at two academic ECMO referral centres in Sydney, Australia. Thirty-seven patients underwent ECPR, 25 (68%) were for in-hospital cardiac arrests. Median age was 54 (IQR 47-58), 27 (73%) were male. Initial rhythm was ventricular fibrillation or pulseless ventricular tachycardia in 20 patients (54%), pulseless electrical activity (n=14, 38%), and asystole (n=3, 8%). 27 (73%) arrests were witnessed and 30 (81%) patients received bystander CPR. Median time from arrest to initiation of ECMO flow was 45min (IQR 30-70), and the median time on ECMO was 3days (IQR 1-6). Angiography was performed in 54% of patients, and 27% required subsequent coronary intervention (stenting or balloon angioplasty 24%). A total of 13 patients (35%) survived to hospital discharge (IHCA 33% vs. OHCA 37%). All survivors were discharged with favourable neurological outcome (Cerebral Performance Category 1 or 2). Pre-ECMO lactate level was predictive of mortality OR 1.35 (1.06-1.73, p=0.016). In selected patients with refractory cardiac arrest, ECPR may provide temporary support as a bridge to intervention or recovery. We report favourable survival and neurological outcomes in one third of patients and pre-ECMO lactate levels predictive of mortality. Further studies are required to determine optimum selection criteria for ECPR.
Two-Hour Lactate Clearance Predicts Negative Outcome in Patients with Cardiorespiratory Insufficiency
Publisher: Hindawi Limited
Date: 2010
DOI: 10.1155/2010/917053
Abstract: Objective . To evaluate 2-hour lactate clearance as a prognostic marker in acute cardiorespiratory insufficiency. Design . Prospective observational study. Setting . Emergency Department (ED) and 16-bed medical High Dependency Unit (HDU). Methods and Main Results . 95 consecutive admissions from the ED for acute cardiorespiratory insufficiency were prospectively enrolled. Arterial lactate concentration was assessed at ED arrival and 1, 2, 6, and 24 hours later. The predictive value of 2-hour lactate clearance was evaluated for negative outcomes defined as hospital mortality or need for endotracheal intubation versus positive outcomes defined as discharge or transfer to a general medical ward. Logistic regression and ROC curves found 2-hour lactate clearance 15% was a strong predictor of negative outcome ( P .0001 ) with a sensitivity of 86% (95% CI = 67 %–95%) and a specificity of 91% (95% CI = 82 %–96%), Positive predictive value was 80% (95% CI = 61 %–92%), and negative predictive value was 92% (95% CI = 84 %–98%). Conclusions . Systematic monitoring of lactate clearance at 2 hours can be used in to identify patients at high risk of negative outcome and perhaps to tailor more aggressive therapy. Equally important is that a 2-hour lactate clearance 15% is highly predictive of positive outcome and may reassure clinicians that the therapeutic approach is appropriate.
Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: a pilot study
Publisher: Springer Science and Business Media LLC
Date: 22-01-2010
DOI: 10.1007/S00134-009-1745-4
Abstract: To investigate whether ultrasound determination of the inferior vena cava diameter (IVCD) and its collapsibility index (IVCCI) could be used to optimize the fluid removal rate while avoiding hypotension during slow continuous ultrafiltration (SCUF). Twenty-four consecutive patients [13 men and 11 women, mean age 72 +/- 5 years New York Heart Association (NYHA) functional classes III-IV] with acute decompensated heart failure (ADHF) and diuretic resistance were admitted to our 16-bed medical ICU. Blood pressure (BP), heart rate (HR), respiratory rate (RR), blood s les for hematocrit, creatinine, sodium, potassium, and arterial BGA plus lactate were obtained at baseline and than every 2 h from the beginning of SCUF. IVCD, assessed by M-mode subcostal echocardiography during spontaneous breathing, was evaluated before SCUF, at 12 h, and just after the cessation of the procedure. The IVCCI was calculated as follows: [(IVCD(max) - IVCD(min))/IVCD(max)] x 100. Mean UF time was 20.3 +/- 4.6 h with a mean volume of 287.6 +/- 96.2 ml h(-1) and a total ultrafiltrate production of 5,780.8 +/- 1,994.6 ml. No significant difference in MAP, HR, RR, and IVCD before and after UF was found. IVCCI increased significantly after UF (P 30%. In all the other patients, a significant increase in IVCCI was obtained without any hemodynamic instability. IVC ultrasound is a rapid, simple, and non-invasive means for bedside monitoring of intravascular volume during SCUF and may guide fluid removal velocity.
In situ E-CPR simulation: Reduced time from cardiac arrest to ECMO flow in actual patients.
Publisher: Wiley
Date: 05-2017
DOI: 10.1002/EJHF.844
Correlation of lung comet score with decreased gas exchange in patients with acute pulmonary edema: a pilot study
Publisher: Springer Science and Business Media LLC
Date: 2010
DOI: 10.1186/CC8499
Related Organisations
London School Of Hygiene And Tropical Medicine
Location: United Kingdom of Great Britain and Northern Ireland
The University Of Notre Dame Australia - Sydney Campus Broadway
Location: Australia
Related Funding Activities
No related grants have been discovered for Dr. Sean Scott.