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Since 2010, infants around the world have been saved from death or severe disability as a result of research conducted by Professor Marianne Thoresen and her team at the University of Bristol. Translational research conducted between 1998 and 2010 by the Thoresen group showed that mild cooling of newborn children who had suffered a lack of oxygen during labour and delivery reduced death and disability by over 50%. Extensive publication on this treatment and practical training for neonatal staff, led by the Bristol team since 2008, has transformed the management of neonatal brain injury. By 2010/11, therapeutic cooling had been adopted as standard treatment throughout the developed world, saving thousands of children from death or severe disability, including cerebral palsy and epilepsy. Therapeutic hypothermia also saves the NHS and UK families about £200 million/year in care and compensation costs.
Imperial College researchers have pioneered the implementation of therapeutic hypothermia to improve survival of neonates following perinatal asphyxia.
Following their programme of clinical research to prove feasibility, Professors Azzopardi and Edwards led the Total Body Hypothermia for Neonatal Encephalopathy Trial (TOBY), a multicentre, randomised trial investigating the effects of total-body cooling for 72 hours in babies with asphyxial encephalopathy from a lack of oxygen at birth. This work demonstrated that infants in the cooled group had an increased rate of survival without neurologic abnormality. This work has influenced public policy and healthcare provision, through the implementation and audit of therapeutic hypothermia nationally and internationally. In the UK, cooling therapy is now carried out in 1000- 1500 cases annually (Data reported to the UK National Register of Cooling). Cooling following perinatal asphyxia is now standard of care in most resource rich and intermediate countries.
Neonatal extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support used in severe but potentially reversible respiratory failure in newborn infants. In 1993 researchers in Leicester carried out the first and, to date, only large-scale randomised trial comparing the value of ECMO with other means of life support. The trial, with follow-up research at 4 and 7-year intervals, has shown ECMO to be a life-saving and cost-effective treatment, and has led to the establishment of a centrally funded neonatal programme that is estimated to have saved around 340 lives in the UK alone. In 2013 the University remains internationally renowned in the field of ECMO research, and since 2009 Glenfield Hospital has been home to the world's largest ECMO centre for the treatment of newborns, older babies and adults. The trial is still held up by advocates of fair clinical trials as an example of how evidence should translate into practice and policy.
This case study demonstrates how research into ground source geothermal cooling has benefited a public service organisation (London Underground Ltd (LUL)), an international engineering consultancy (Parsons Brinckerhoff (PB)) and the safety and comfort of staff and users of the London Underground.
Impact includes: