BEWT FUNDRAISING WILL HELP FUND 5 NURSE SPECIALISTS WITHIN THE CEREBROVASCULAR NEUROSURGERY TEAM AT SOUTHMEAD HOSPITAL

Following substantial support from the Billie Elizabeth Wood Trust (BEWT), the Bristol Neurovascular Research Network (Bristol-NRN) has been established at Southmead Hospital. The newly established team is focusing on developing and delivering research into Sub-Arachnoid Haemorrhage (SAH) and Vasospasm trends and management.

Since the appointment of a Research Facilitator and Research Nurse, the new team at Southmead has been key collaborators on a large-scale Observational Study taking place across the UK and Ireland. Southmead Hospital is contributing key data from Bristol to help understand the effectiveness of brain drain insertion and induced high Blood Pressure and therapy for the arteries when blood supply is reduced in the brain. By analysing this data it is hoped that this frequent complication of SAH can be reduced.

In addition, a Quality-of-Life Study has been started - the first step of a multi-stage research project to understand what happens to SAH patients after they have been discharged from hospital. By investigating the quality of life and unmet needs of these patients after leaving hospital, we can find ways to improve care for patients, relatives and carers impacted by SAH.

Finally, the team have been raising the profile of the Bristol-NRN with other clinical experts at a national level, and by engaging patients and members of the public. A dedicated Patient and Public Involvement and Engagement (PPIE) group for SAH has begun to be established. PPIE is essential when planning, designing and delivering research. It improves the chances of successful recruitment of patients to studies and clinical trials and ensures new care pathways and treatments are meaningful to the patients they will affect. 

Over the next six to 12 months, BEWT’s investment in the Research Nursing post will be split across 5 Nurse Specialists within the cerebrovascular neurosurgery team at Southmead Hospital. This will allow the Network to expand, pool skills and experience, and provide a more flexible service for delivering Research in this important area. The nursing team will also drive the Quality-of-Life study forward. 

The team are part of a Genomics study – working with key collaborators to help determine whether a specific gene is associated with SAH and the outcome. This will provide insight into the pathophysiology of brain injury after SAH and potentially target the development of treatments to improve patient outcomes.

In addition to this, the team will be exploring the link between abnormal sodium levels and Vasospasm – they will investigate the evidence in the existing scientific literature to see what the impact of abnormal sodium levels in the blood and urine is on the development of vasospasm following SAH. There is preliminary data in the literature on the link between abnormal and uncorrected sodium levels leading to poorer outcomes after SAH. In our intensive care unit, the electronic digital records provide countless data points to allow complex analyses. We’re also working on collaboration with the engineering school at the University of Bristol to support this work.

We had previously announced two new members of specialist research staff - a vasospasm research nurse and a research facilitator - however to ensure efficacy of the BEWT funding and utilise existing experience within the entire neuro clinical nursing team, funding will now support dedicated time for the whole team to focus on vasospasm research which in turn facilitates the simultaneous exploration of multiple research avenues and embeds vasospasm research across the neuroscience division.

Humza Saeed is the new research facilitator, and he will support the neurosurgery team to identify areas where vasospasm and SAH-related work can be focused to improved care. Humza will also help this team to identify potential funding avenues for future research, such as clinical trials, and establish and grow the vasospasm research team to conduct this ‘home-grown’ research, which is to support Southmead in becoming a centre of excellence for vasospasm research.

“The R&D department at North Bristol NHS Trust has produced a broad range of amazing research output in the last decade,” Humza notes. “I am keen to drive similar output within the area of subarachnoid haemorrhage and vasospasm. I believe the neurosurgery team at Southmead has the potential to grow to become a globally recognised centre of research excellence.”

Humza also underlines the importance of data collection and analysis. “Data helps us to devise, understand and answer complex research questions,” he explains. “It provides evidence which can then be used to inform clinical decision making and policy making. This will ultimately benefit patient care and improve patient outcomes.”

One of the BEWT fundraising charity’s key objectives has always been to try to spare other families the pain of losing a loved one to SAH. In the medical field, knowledge is power.

Extensive research is so important – and ultimately helps to save more lives.

The newly established Southmead Hospital Charity Vasospasm research team is committed to advancing our comprehension of this critical medical condition. A primary focus of their research lies in exploring the genetic factors associated with Vasospasm, a debilitating consequence that arises in 70% of SAH cases. By delving into the genetic landscape, the team aims to identify key genes linked to Vasospasm, paving the way for targeted interventions.

Another crucial area of exploration involves restoring sodium levels in patients affected by SAH. Disruptions in sodium balance can exacerbate the severity of vasospasm, and the team seeks to unravel approaches to normalise these levels effectively. Additionally, the researchers will explore methods for draining excess brain fluid, a factor that can contribute to complications post-SAH.

Acknowledging the profound impact of SAH on the quality of life, the research team will also delve into the aftermath of Vasospasm. Understanding the long-term implications and devising strategies to enhance the quality of life for individuals who have experienced Vasospasm will be a crucial aspect of their comprehensive approach. Through their investigations, the Southmead Hospital Charity research team aspires to contribute significantly to the global efforts aimed at better detection, treatment, and overall management of this complex medical condition.

Billie’s father, Richard Wood shares his thoughts on this exciting news, “My daughter’s sudden death at such a young age was heartbreaking for family and friends and we know she would support our aim to help others who may find themselves in a similar situation. She would be extremely proud of the way in which we have managed to make a difference with the appointment of these two new roles.”

Need for Neurovascular Vasospasm Research Support in Bristol

Aneurysmal subarachnoid haemorrhage (aSAH) is an acute cerebrovascular event characterised by the rupture of an aneurysm within the subarachnoid space and the release of blood over the surface of the brain. Patients may present with sudden collapse, severe headache or acute neurological dysfunction. Initial management is supportive together with securing the aneurysm by endovascular or surgical means. The incidence is around 10 cases per 100,000 person year. Up to 35% of patients with aSAH do not survive the initial bleed and a significant proportion of survivors suffer a secondary ischaemic insult, resulting in overall high morbidity and mortality. People may be left with physical disabilities, including speech, motor, balance, sensory or visual perceptual problems, which affect their ability to care for themselves. There is now increasing recognition of the impact of longer-term cognitive and higher mental dysfunction which also poses a significant socioeconomic burden.

Ischaemic brain damage following aSAH can present clinically as a sudden deterioration in neurological function, often called delayed cerebral ischaemia (DCI), occurring in up to 30% of patients. This most commonly occurs between the fourth and tenth day after aSAH. More recently the term “early brain injury” has been used to describe the mechanisms underlying acute neurological deterioration following aSAH that include cell death, cerebral oedema and neuronal dysfunction that occur following the initial bleed. Preclinical and autopsy studies illustrate the heterogeneity of pathological phenomena that may manifest as neurological dysfunction after aSAH. The causes of brain injury after aSAH are multifactorial and include classic angiographic spasm, microvascular spasm, microthromboembolism, direct inflammatory neuro-toxicity and spreading depolarisation. Treatment to prevent or limit brain injury is focused on high dependency care including maintenance of cardiac output, early recognition of infection, avoidance of hyperglycaemia and maintenance of high cerebral blood flow.

The only evidence-based pharmacological intervention is the reduction of vascular spasm using calcium channel antagonism with nimodopine. These limited treatments reveal a pressing need to develop additional therapies that treat the underlying pathophysiological mechanism of brain injury following aSAH.

With the support, we in Bristol are keen to participate in a multicentre high-quality study to look into the effect of a new drug (IL1Ra) in reducing the risk of vasospasm in aSAH patients and hopefully then result in outcome improvement. Furthermore, we also aim to take part in an international study to map out the genomic contributions of vasospasm.