Meet our Researchers - Finding the Answers that help ISCRR make a difference
Professor Jamie Cooper manages an expansive portfolio of research in intensive care medicine and mentors the next generation of clinician-scientists.
In his multi-faceted career at Monash University and Alfred Health, Professor Cooper has played significant leadership roles as clinician, researcher, educator and mentor.
Under his leadership, the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University has earned an international reputation for training critical care specialists in the methodology and execution of clinical research and pivotal multi-centre trials.
His research has challenged prevailing dogmas and led to improved patient outcomes and major financial savings to the Australian healthcare system.
Where do you work?
I work in Melbourne in the Alfred Medical Research and Education Precinct (AMREP), a leading centre integrating biomedical and clinical research, education and health care. The AMREP is a collaborative partnership including Alfred Health and Monash University.
At Monash University I am a full Professor of Intensive Care Medicine; the Director of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC); Director of the Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma (Blood-CRE); and the Head of Critical Care Research in the School of Public Health and Preventive Medicine.
At Alfred Health I am a Senior Specialist in Intensive Care and the Deputy Director and Head of Research in the Department of Intensive Care.
I am also a National Health and Medical Research Council (NHMRC) Practitioner Fellow, and Hon. Professorial Fellow in the Critical Care and Trauma Division at The George Institute for Global Health, University of Sydney.
Where were you prior to starting at The Alfred?
Prior to starting at The Alfred, I trained at medicine and intensive care in Adelaide then undertook a research fellowship at University of British Columbia, Canada.
How long have you been a researcher with ISCRR?
I have been a researcher with ISCRR since 2012, but have worked with the TAC on many projects since 1998.
What area of research are you working in and what attracted you to this type of research?
My research foci include randomised clinical trials in traumatic brain injury, blood transfusion, sepsis, acute lung injury, and resuscitation fluids.
I was drawn into research because I wanted to be part of the national research effort to determine the best and most cost-effective practice in Intensive Care. For more than 20 years I have been affiliated with the Australian and New Zealand Intensive Care Society's Clinical Trials Group (CTG) including three years as Chair. The CTG is a bi-national network of collaborating clinicians that has achieved international recognition as one of the two most successful and influential independent clinical research consortia in critical care in the world and continually generates new evidence to improve outcomes for critically ill patients. This group is responsible for a quarter of all original articles from Australia published in the New England Journal of Medicine (Impact factor 51.658) in the past decade, and it has completed the three largest ICU trials in the world to date.
What do you like best about your role?
What I like best about my role is the opportunity to improve outcomes for critically ill patients; working with our wonderful teams of dedicated people both in Australia and internationally; and mentoring the next generation of clinician-scientists.
What was the most fulfilling piece of research you completed?
The DECRA trial was the most fulfilling piece of research that I have completed (Cooper DJ, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493-502).
The DECRA trial demonstrated unexpectedly inferior long-term outcomes for an increasingly popular surgical intervention (early decompressive craniectomy) that was opposite to apparent short-term benefits and has initiated international TBI practice review. The trial results have been a watershed in changing current practice and have proved invaluable from both an individual patient and community perspective. This was the first Level I evidence in this area and is being incorporated into the international Brain Trauma Foundation practice guidelines. Using alternative therapies will improve TBI patient outcomes and substantially reduce health care spending on lifetime care of severe disability survivors.
Very few randomised trials are ever conducted in neurotrauma care, because they are so difficult to accomplish. The DECRA trial was the first ever multi-centre randomised controlled trial in adults of a surgical therapy for severe head injury. DECRA was a trial of a neurosurgical procedure that had become regularly used in critically ill trauma patients, and it studied a key group of severe TBI patients who had brain swelling that was refractory to usual therapies. Prior to DECRA, it was considered that effective pressure control using neurosurgery would benefit patients, and craniectomy was being increasingly chosen above alternative medical therapy both in civilian trauma and in combat zones. There were clear short-term benefits from this surgery.
However, DECRA discovered something completely new to neurosurgeons. After craniectomy surgery, the short-term measures including pressure control, and patient times receiving life support and in ICU all improved, but, contrary to many expectations, DECRA surgery also led to increased severely disabled, dependent, and vegetative, functional outcomes 6 months after injury. The patients who received enhanced medical therapy were able to function at a higher level 6 months after injury.
This discovery led to a substantial rethink world-wide of the pros and cons of craniectomy surgery and the medical alternatives in severe head injury patients. It has also led to major rethinking of brain pressure targets in severe TBI patients, as aggressive control was not beneficial and may have had unexpected side effects.
DECRA is a classic example of advances that can be made by conducting careful randomised controlled trials, even in very complex neurotrauma patients. It established the importance of placing long-term patient function at the top of specialists' therapeutic goals, and that medical barbiturate coma was much more effective than previously considered. Finally, DECRA raised a new paradigm – that craniectomy surgery may enable brain fibres to stretch and damage.
The NEJM DECRA publication was controversial, and has received international recognition as a landmark practice-changing and questioning trial.
The DECRA trial was described by Cambridge Neurotrauma specialists as "a fundamental event in the history of decompressive craniectomy for traumatic brain injury (TBI)" (Hutchinson PJ, et al. Br J Neurosurg 2011;25:441-2) and "one of the most important clinical trials of a novel therapy for severe TBI, and a class 1 study which should be considered as foundation for an evidence based guideline" (Marion DW. Lancet Neurol 2011;10:497-8). Yale University identified the value of the research by selecting the DECRA trial for its book on the top 50 neurological papers of all time.
How is your research benefiting/providing impact WorkSafe /VWA and the TAC?
Access Economics' report of lifetime costs of severe TBI patients in Australia has enabled estimates that preference for barbiturates instead of craniectomy could save the Australian Health Care System hundreds of millions of dollars annually. The world impact of this trial is already clear, but the total impact to patients and health care systems is only beginning to be quantified.
What is the best piece of advice you've been given, and what would you give?
The best advice that I've been given is "timing is everything".
The advice that I would give is to collaborate widely and stay determined. Victoria has wonderful talent in critical care, and by working together we can lead the world.
Describe yourself in three words.
Motivator, facilitator and collaborator.