Completed Early Career Practitioner Fellowship:
Alistair Nichol
Host Organisation: Monash University
TAC Funding: $163,135
Mentor: Professor Jamie Cooper
Fellowship Project:
The Prophylactic Hypothermia to lessen Traumatic Brain Injury-Randomised Control
Trial (POLAR RCT)
Aims:
Traumatic brain injury (TBI) is a leading cause of death and long term disability,
particularly in young adults. Studies from Australia have shown that approximately
half of those with severe traumatic brain injury will be severely disabled or dead 6
months post injury. Given the young age of many patients with severe TBI and the
long term prevalence of major disability, the economic and more importantly the
social cost to the community is very high.
Methods:
The POLAR trial has been developed to investigate whether early cooling of patients
with severe traumatic brain injury is associated with better outcomes. It is a
randomised controlled trial, which is a type of trial that provides the highest quality of
evidence. Unconscious patients will be assessed by the ambulance service and if
found to be suitable for the trial they will receive cooling by an infusion of chilled
salty fluid (Intervention group) or they will be treated in the normal manner (Control
group). Allocation to the two groups occurs randomly like flipping a coin. On arrival
to hospital cooled patients will be checked to make sure it is safe to continue cooling
and if so they will be cooled by temperature control pads placed on the skin. Control
group patients will also have the pads applied. The cooled group will have the
temperature set to 330C and the control group to 370C. The temperature pads will
stay in place for up to 7 days. Data will be collected during the pre-hospital stage and
the hospital admission. The patient’s recovery will be measured at 6 months post the
injury.
Results:
At completion of the fellowship, the trial has included 100 patients out of a total
anticipated sample size of 514 patients.
Conclusions:
The final study results for the POLAR study are pending.
Career Development:
Alistair participated in the following activities during the course of his fellowship:

Alistair is the current chair of the EPO:TBI study and an investigator on a
proposed neuro-imaging study in TBI

Alistair has assisted in the supervision of a Senior Research Fellow, and is also
a PhD supervisor

Attended the Harvard MPH, Clinical effectiveness summer program.


Assisted with international trials and studies trial methodology at Harvard.
MA, USA.
Produced multiple National and International publications, as well as a
substantial publication record.
Feedback on the Fellowship from Alistair Nichol:
“It was super!! It allowed me to transition from Senior Lecturer to Professor. It
facilitated the huge amount of research in this project (and others). It allowed me to
develop a worldwide network of colleagues in TBI, with who I continue to work.
Finally it will allow me to work on this world class project (POLAR). Thanks, I could
not recommend it higher.”
Publications:
The ANZIC Influenza Investigators. Influenza A (H1N1) 2009: Impact on Critical Care Services
during the Australian and New Zealand Winter. New England Journal of Medicine.
2009;361(20):1925-1934.
NICHOL AD, NAUGHTON F, CRONIN DO, BOYLAN J, MCLOUGHLIN P. Infection-induced lung
injury is worsened after renal buffering of hypercapnic acidosis. Critical Care Medicine.
2009;37(11):2953-2961.
PETTILÄ V, NICHOL A, BELLOMO R, COOPER DJ. Red blood cell transfusion and mortality in
spontaneous subarachnoid hemorrhage. Critical Care Medicine. 2009;37(11):2996-2997.
BARBETTI JK, NICHOL AD, CHOATE KR, BAILEY MJ, LEE GA, COOPER DJ. Prospective
observational study of complications with Percutaneous Dilatational Tracheostomy and Surgical
Tracheostomy in 1163 Critically Ill Patients. Critical Care Resuscitation. 2009;11(4):244-9.
ROBERTSON M, HIGGINS L, NICHOL AD, BELLOMO R, COOPER DJ. Venous
Thromboembolism Prophylaxis in the Critically Ill: A Point Prevalence Survey of Current Practice in
Australian and New Zealand Intensive Care Units. Critical Care and Resuscitation, 2010;12(1):9-15.
HIGGINS L, PETTILA V, NICHOL AD, BELLOMO R, COOPER DJ, MORRISON SS. Expensive
care - a rationale for economic evaluations in intensive care. Critical Care Resuscitation.
2010;12(1):62-6.
NICHOL AD, GABBE B, HIGGINS L, CAMERON P, MURRAY LJ, COOPER DJ. Measuring
functional and quality of life outcomes following major head injury: Common scales and checklists.
Injury. 2011 Mar;42(3):281-7.
MOORE E, BELLOMO R, NICHOL A. Biomarkers of acute kidney injury in intensive care and major
surgery: from the lab to clinical research to clinical practice. Minerva Anestesiologica 2010;76(6):42540.
PETTILÄ V, WESTBROOK AJ, NICHOL AD, BAILEY MJ, WOOD EM, SYRES G, PHILLIPS LE,
STREET A, FRENCH C, MURRAY L, ORFORD N, SANTAMARIA JD, BELLOMO R, COOPER
DJ. Transfusion practice and guidelines in Australian and New Zealand Intensive Care Units. The
Blood Observational Study Investigators on behalf of the ANZICS- Clinical Trials Group. Intensive
Care Medicine. 2010:36(7):1138-1146.
MOORE EM, BELLOMO R, NICHOL AD, HARLEY N, MACISAAC C, COOPER DJ. The
incidence of acute kidney injury in patients with traumatic brain injury. Renal Failure 2010;32(9):10601065.
NICHOL AD, O`CRONIN DF, NAUGHTON F, HOPKINS N, BOYLAN J, MCLOUGHLIN P.
Hypercapnic acidosis reduces oxidative reactions in endotoxin induced lung injury. Anesthesiology.
2010; 2010 Jul;113(1):116-25.
NICHOL A, PETTILÄ V, WESTBROOK AJ, NICHOL AD, BAILEY MJ, WOOD EM, SYRES G,
PHILLIPS LE, STREET A, FRENCH C, MURRAY L, ORFORD N, SANTAMARIA JD, BELLOMO
R, COOPER DJ. Age of red blood cells and mortality in the critically ill. The Blood Observational
Study Investigators on behalf of the ANZICS- Clinical Trials Group. Critical Care Medicine.2011,
15:R116.
THE ANZIC INFLUENZA INVESTIGATORS AND AUSTRALASIAN MATERNITY OUTCOMES
SURVEILLANCE SYSTEM. (NICHOL AD is an ANZIC Influenza Chief Investigator and
Management Committee Member) The management committee (S. Webb., V Pettilä., I Seppelt, R
Bellomo, M Bailey, DJ. Cooper, M Cretikos, AR. Davies, SFinfer, P Harrigan, G Hart, B Howe, J.
Iredell, C McArthur, I Mitchell, S Morrison, AD Nichol, D Paterson, S Peake, B Richards, D Stephen,
ATurner, M Yung). Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women:
population based cohort study British Medical Journal BMJ. 2010;340:c1235.
NICHOL AD, EGI M, PETTILÄ V, BELLOMO R, FRENCH C, HART G, DAVIES A,
STACHOWSKI E, READE MC, BAILEY M, COOPER DJ. Relative hyperlactatemia and hospital
mortality in critically ill patients: a retrospective multi-centre study. Critical Care. 2010;14(1):R25.
NICHOL A, BAILEY M, COOPER DJ; On behalf of the POLAR and EPO investigators. Challenging
issues in randomized controlled trials. Injury. 2010;41 Suppl 1:S20-3.
SEPPELT I, NICHOL A (An ANZAC Influenza Investigator). Critical illness due to 2009 A/H1N1
influenza in pregnant and postpartum women: Population based cohort study. BMJ (Online)
2010;340(7749):751.
CURLEY G, CONTRERAS MM, NICHOL AD, HIGGINS BD, LAFFEY JG. Hypercapnia and
Acidosis in Sepsis: A Double-edged Sword? Anesthesiology 2010;112(2):462-72.
NICHOL A, PETTILLA V, COOPER DJ. What is the optimal method for weaning and liberation from
Mechanical Ventilation? In Deutschman CS, Neligan PJ, Editors. Evidence-based practice of critical
care. Philadelphia, PA, U.S.A: Saunders Elsevier; 2010. p.37-44.
ANZIC Influenza Investigators (NICHOL A - an ANZIC Influenza Investigator). Critical care services
and the H1N1 (2009) influenza epidemic in Australia and New Zealand in 2010: The impact of the
second winter epidemic. Critical Care 2011;15(3) Art No. R143.
MOORE EM, NICHOL AD, BERNARD SA, BELLOMO R. Therapeutic hypothermia: Benefits,
mechanisms and potential clinical in neurological, cardiac and kidney injury. Injury 2011;42(9):843854.
NICHOL AD. Permissive hypercapnia in acute respiratory distress syndrome - is now the time to get
strict? Critical Care and resuscitation: journal of the Australasian Academy of Critical Care Medicine
2011; 13(3):142-143.
NICHOL A, BAILEY M, EGI M, PETTILA V, FRENCH C, STACHOWSKI E, READE MC,
COOPER DJ, BELLOMO R. Dynamic lactate indices as predictors of outcome in critically ill patients.
Critical Care 2011;15(5):R242.
PETTILA V, WEBB SAR, BAILEY M, HOWE B, SEPPELT IM, BELLOMO R. Acute kidney injury
in patients with influenza A (H1N1) 2009. Intensive Care 2011;37(5):763-767.
BELLOMO R, BAILEY M, EASTWOOD GM, NICHOL A, PILCHER D, HART GK, READE MC,
EGI M, COOPER DJ. Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac
arrest. Critical Care 2011;15(2); Art No R90.
HODGSON CL, TUXEN DV, DAVIES AR, BAILEY MJ, HIGGINS AM, HOLLAND AE,
KEATING JL, PILCHER DV, WESTBROOK AJ, COOPER DJ, NICHOL AD. A randomised
controlled trial of an open lung strategy with staircase recruitment, titrated PEEP and targeted low
airway pressures in patients with acute respiratory distress syndrome. Critical Care 2011;15(3): Art No.
R133.
MOORE E, BELLOMO R, NICHOL AD. Erythropoietin (EPO) as a novel brain and kidney protective
agent. Anaesthesia and Intensive Care. 2011 May;39(3):356-72.
NICHOL A, TOAL F, FEDI M, COOPER DJ. Early outcome prediction after severe traumatic brain
injury: can multimodal MRI assist clinical prognostication for individual patients? Critical Care
Resuscitation. 2011 Mar;13(1):5-8.
EGI M, KIM I, NICHOL A, STACHOWSKI E, FRENCH CJ, HART GK, HEGARTY C, BAILEY M,
BELLOMO R. Ionized calcium concentration and outcome in critical illness. Crit Care Med.
2011;39(2):314-21.
NICHOL AD, TRAPANI T, MURRAY L, VALLANCE S, COOPER DJ. Hypothermia in patients
with brain injury: The way forward? The Lancet Neurology 2011;10(5):405.
HEW S, NICHOL A. Acute pancreatitis: An intensive care perspective. Anaesthesia and Intensive Care
Medicine 2012;13(4):181-175.
AUBRON C, SYRES G, NICHOL A, BAILEY M, BOARD J, MAGRIN G, MURRAY L,
PRESNEILL J, SUTTON J, VALLANCE S, MORRISON S, BOLLOMO R, COOPER DJ. A pilot
feasibility trial of allocation of freshest available red blood cells versus standard care in critically ill
patients. Transfusion 2012(6)1196-202.
HANNA J, NICHOL A. Acute renal failure and the critically ill. Anaesthesia and Intensive Care
Medicine 2012;13(4):166-170.
MOORE E, BERNARD S, COOPER J, NICHOL A. Hypothermia: history, mechanisms,
complications, indications and future directions. Hypothermia: Prevention, Recognition and Treatment.
Nova Publishings 2012(3);43-68.
GANTNER D, NICHOL A. Treatment of severe sepsis. Anaesthesia and Intensive Care Medicine.
2012;13(5):199-203.
PRAEGER AJ, WESTBROOK AJ, NICHOL AD, WIJEMUNIGE R, DAVIES AR, LYON SM,
WILLS JL, BAILEY M, ROSENFELD JV, COOPER DJ. Deep vein thrombosis and pulmonary
embolus in patients with traumatic brain injury: a prospective observational study. Crit Care Resusc.
2012;14(1): 13.
HANNA J, NICHOL A. Status epilepticus: An intensive care medicine problem. Anaesthesia and
Intensive Care Medicine 2012; 13(4):148-151.
Presentations:
NICHOL A. Novel ideas in Traumatic brain injury. Trauma Melbourne; 2009 November 20-21,
Melbourne, Australia.
NICHOL A. Bacterial load in severe sepsis. Australia New Zealand Intensive Care Society-Clinical
Trials Group; 2009 May 2-6, Queensland, Australia.
NICHOL A. Hypothermia in Intensive care in 2009. The Intensive Care Society of Ireland - Annual
Scientific Meeting; 2009 June 12-13, Dublin, Ireland.
NICHOL A. Challenging Issues in RCTs. Trauma Melbourne; 2009 November 20-21, Melbourne,
Australia.
NICHOL A. How to cool and when to cool-Hypothermia in ICU. Australia New Zealand Intensive
Care Society-ASM; 2009 October 29-31, Perth, Australia.
NICHOL A. Relative hyperlactatemia and hospital mortality in critically ill patients. Irish Congress of
Anaesthesia; 2010 May 21-21, Dublin, Ireland.
NICHOL A. Come over and say G'day clinical trials down under. Irish Congress of Anaesthesia; 2010
May 21-21, Dublin, Ireland.
NICHOL A. Novel ideas in Traumatic brain injury. Trauma Melbourne; 2009 November 19-21,
Melbourne, Australia.
NICHOL AD. The magic bullet in TBI- a clinical trials perspective. Trauma Melbourne; 2010
November 19-21, Melbourne, Australia.
NICHOL AD. Novel treatments in traumatic brain injury. European Society of Intensive Care
Medicine, Acute Brain Injury Conference; 2010 June 10-12, Dublin, Ireland.
NICHOL A, PHARLAP. A pilot randomized controlled trial. American Thoracic Society; 2010 May
14 -19, New Orleans, USA.
NICHOL A. Erythropoietin in TBI. Australia New Zealand Intensive Care Society 2010, Melbourne,
Australia.
NICHOL A. Bacterial levels in severe sepsis. Australia New Zealand Intensive Care Society 2010,
Melbourne, Australia.