235 results found
Granfeldt A, Avis SR, Lind PC, et al., 2020, Intravenous vs. intraosseous administration of drugs during cardiac arrest: A systematic review, RESUSCITATION, Vol: 149, Pages: 150-157, ISSN: 0300-9572
de Caen A, Moylan A, Maconochie IK, 2020, Epinephrine for Pediatric Out-of-Hospital Cardiac Arrest Some Reassurance, but no Answers, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 75, Pages: 205-206, ISSN: 0735-1097
Deluca P, Coulton S, Alam MF, et al., Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs, Programme Grants for Applied Research, Vol: 8, Pages: 1-144, ISSN: 2050-4322
<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs).</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Objectives</jats:title> <jats:p>To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs).</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Twelve EDs in England (London, North East, and Yorkshire and The Humber).</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title>
Soar J, Maconochie I, Wyckoff MH, et al., 2019, 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, RESUSCITATION, Vol: 145, Pages: 95-150, ISSN: 0300-9572
Wen SH, Ong GY-K, Maconochie IK, et al., 2019, Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections, EMERGENCY MEDICINE JOURNAL, Vol: 36, Pages: 729-735, ISSN: 1472-0205
Soar J, Maconochie I, Wyckoff MH, et al., 2019, 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, Resuscitation, Vol: 145, Pages: 95-150, ISSN: 0300-9572
Wang X, Nijman R, Camuzeaux S, et al., 2019, Plasma lipid profiles discriminate bacterial from viral infection in febrile children, Scientific Reports, Vol: 9, ISSN: 2045-2322
Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The ‘omics’ approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n=20) and confirmed viral infection (n=20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group..A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics.
Feather C, Appelbaum N, Clarke J, et al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, BMJ Open, Vol: 9, Pages: 1-13, ISSN: 2044-6055
Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors.Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.
Nolan JP, Berg RA, Andersen LW, et al., 2019, Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia), RESUSCITATION, Vol: 144, Pages: 166-177, ISSN: 0300-9572
Bressan S, Titomanlio L, Gomez B, et al., 2019, Research priorities for European paediatric emergency medicine, Archives of Disease in Childhood, Vol: 104, Pages: 869-873, ISSN: 0003-9888
Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects.Design and Setting We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic.Results Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions ‘fever’, ‘sepsis’ and ‘respiratory infections’, and the processes/interventions ‘biomarkers’, ‘risk stratification’ and ‘practice variation’ as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research.Conclusions While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.
Kandasamy J, Theobald PS, Maconochie IK, et al., 2019, Can real-time feedback improve the simulated infant cardiopulmonary resuscitation performance of basic life support and lay rescuers?, ARCHIVES OF DISEASE IN CHILDHOOD, Vol: 104, Pages: 793-801, ISSN: 0003-9888
MacOnochie IK, 2019, Highlights from this issue, Emergency Medicine Journal, Vol: 36, ISSN: 1472-0205
Appelbaum N, Clarke J, Feather C, et al., 2019, Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, Publisher: Cold Spring Harbor Laboratory
<jats:p>Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contributory role of individual process step discrepancies to these errors.Methods: We conducted a prospective observational study of simulated resuscitations subject to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.</jats:p>
Borensztajn D, Yeung S, Hagedoorn NN, et al., 2019, Diversity in the emergency care for febrile children in Europe: a questionnaire study, BMJ Paediatrics Open, Vol: 3, ISSN: 2399-9772
Objective: To provide an overview of care in emergency departments (EDs) across Europe in order to interpret observational data and implement interventions regarding the management of febrile children. Design and setting: An electronic questionnaire was sent to the principal investigators of an ongoing study (PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), www.perform2020.eu) in 11 European hospitals in eight countries: Austria, Germany, Greece, Latvia, the Netherlands, Slovenia, Spain and the UK. Outcome measures: The questionnaire covered indicators in three domains: local ED quality (supervision, guideline availability, paper vs electronic health records), organisation of healthcare (primary care, immunisation), and local factors influencing or reflecting resource use (availability of point-of-care tests, admission rates). Results: Reported admission rates ranged from 4% to 51%. In six settings (Athens, Graz, Ljubljana, Riga, Rotterdam, Santiago de Compostela), the supervising ED physicians were general paediatricians, in two (Liverpool, London) these were paediatric emergency physicians, in two (Nijmegen, Newcastle) supervision could take place by either a general paediatrician or a general emergency physician, and in one (München) this could be either a general paediatrician or a paediatric emergency physician. The supervising physician was present on site in all settings during office hours and in five out of eleven settings during out-of-office hours. Guidelines for fever and sepsis were available in all settings; however, the type of guideline that was used differed. Primary care was available in all settings during office hours and in eight during out-of-office hours. There were differences in routine immunisations as well as in additional immunisations that were offered; immunisation rates varied between and within countries. Conclusion: Differences in local, regional and national aspects of care exist in th
Moylan A, Maconochie I, 2019, Demand, overcrowding and the pediatric emergency department, CANADIAN MEDICAL ASSOCIATION JOURNAL, Vol: 191, Pages: E625-E626, ISSN: 0820-3946
Buick JE, Wallner C, Aickin R, et al., 2019, Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis, RESUSCITATION, Vol: 139, Pages: 65-75, ISSN: 0300-9572
Shehadeh AJ, Soliman A, Maconochie I, 2019, Review of resuscitation physiology in children, Paediatrics and Child Health (United Kingdom), Vol: 29, Pages: 205-209, ISSN: 1751-7222
© 2019 More than one quarter of children survive to hospital discharge after in-hospital cardiac arrests, and 5–10% of children survive to hospital discharge after out-of-hospital cardiac arrests. Cardio-pulmonary resuscitation (CPR)differs in children from adults. Following the Airway, Breathing, Circulation format, this article reviews the physiology of paediatric cardio-pulmonary resuscitation. It addresses the appropriate interventions during CPR, mechanisms of action of commonly used drugs and special resuscitation circumstances: premature and newly born infants, traumatic cardiac arrest, and ECMO (Extracorporeal Membrane Oxygenation). New exciting discoveries in resuscitation science postulate that the key factor in improving outcomes of paediatric cardiac arrest is improving the quality of interventions. A thorough understanding of the physiology underpinning CPR is helpful in ensuring optimal delivery of CPR in children and improving clinical outcomes.
Lavonas EJ, Ohshimo S, Nation K, et al., 2019, Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis, RESUSCITATION, Vol: 138, Pages: 114-128, ISSN: 0300-9572
Moylan A, Appelbaum N, Clarke J, et al., 2019, Assessing the agreement of 5 ideal body weight calculations for selecting medication dosages for children with obesity, JAMA Pediatrics, ISSN: 2168-6203
van de Maat J, van de Voort E, Mintegi S, et al., 2019, Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study, LANCET INFECTIOUS DISEASES, Vol: 19, Pages: 382-391, ISSN: 1473-3099
Chapman SM, Maconochie IK, 2019, Early warning scores in paediatrics: an overview, Archives of Disease in Childhood, Vol: 104, Pages: 395-399, ISSN: 1468-2044
Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a 'threshold' when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children's hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient's specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.
Coulton S, Alam MF, Boniface S, et al., 2019, Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools, JOURNAL OF PUBLIC HEALTH, Vol: 41, Pages: E53-E60, ISSN: 1741-3842
Soar J, Perkins GD, Maconochie I, et al., 2019, European Resuscitation Council Guidelines for Resuscitation: 2018 update – antiarrhythmic drugs for cardiac arrest, Resuscitation, Vol: 134, Pages: 99-103, ISSN: 0300-9572
This European Resuscitation Council (ERC) Guidelines for Resuscitation 2018 update is focused on the role of antiarrhythmic drugs during advanced life support for cardiac arrest with shock refractory ventricular fibrillation/pulseless ventricular tachycardia in adults, children and infants. This update follows the publication of the International Liaison Committee on Resuscitation (ILCOR) 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The ILCOR CoSTR suggests that any beneficial effects of amiodarone or lidocaine are similar. This ERC update does not make any major changes to the recommendations for the use of antiarrhythmic drugs during advanced life support for shock refractory cardiac arrest.
Soar J, Donnino MW, Maconochie I, et al., 2018, 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations summary, Circulation, Vol: 138, Pages: e714-e730, ISSN: 0009-7322
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria. The statements include consensus treatment recommendations approved by members of the relevant task forces. Insights into the deliberations of each task force are provided in the Values and Preferences and Task Force Insights sections. Finally, the task force members have listed the top knowledge gaps for further research.
Ahmad F, Soe S, White N, et al., 2018, Region-specific microstructure in the neonatal ventricles of a porcine model, Annals of Biomedical Engineering, Vol: 46, Pages: 2162-2176, ISSN: 0090-6964
The neonate transitions from placenta-derived oxygen, to supply from the pulmonary system, moments after birth. This requires a series of structural developments to divert more blood through the right heart and onto the lungs, with the tissue quickly remodelling to the changing ventricular workload. In some cases, however, the heart structure does not fully develop causing poor circulation and inefficient oxygenation, which is associated with an increase in mortality and morbidity. This study focuses on developing an enhanced knowledge of the 1-day old heart, quantifying the region-specific microstructural parameters of the tissue. This will enable more accurate mathematical and computational simulations of the young heart. Hearts were dissected from 12, 1-day-old deceased Yorkshire piglets (mass: 2.1–2.4 kg, length: 0.38–0.51 m), acquired from a breeding farm. Evans blue dye was used to label the heart equator and to demarcate the left and right ventricle free walls. Two hearts were used for three-dimensional diffusion-tensor magnetic resonance imaging, to quantify the fractional anisotropy (FA). The remaining hearts were used for two-photon excited fluorescence and second-harmonic generation microscopy, to quantify the cardiomyocyte and collagen fibril structures within the anterior and posterior aspects of the right and left ventricles. FA varied significantly across both ventricles, with the greatest in the equatorial region, followed by the base and apex. The FA in each right ventricular region was statistically greater than that in the left. Cardiomyocyte and collagen fibre rotation was greatest in the anterior wall of both ventricles, with less dispersion when compared to the posterior walls. In defining these key parameters, this study provides a valuable insight into the 1-day-old heart that will provide a valuable platform for further investigation the normal and abnormal heart using mathematical and computational models.
Soar J, Donnino MW, Maconochie I, et al., 2018, 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary, RESUSCITATION, Vol: 133, Pages: 194-206, ISSN: 0300-9572
de Caen A, Maconochie I, 2018, EtCO2 measurement during pediatric cardiac arrest: Does the Emperor have no clothes?, Resuscitation, Vol: 133, Pages: A1-A2, ISSN: 0300-9572
Ahmad F, Prabhu R, Liao J, et al., 2018, Biomechanical properties and microstructure of neonatal porcine ventricles, Journal of the Mechanical Behavior of Biomedical Materials, Vol: 88, Pages: 18-28, ISSN: 1751-6161
Neonatal heart disorders represent a major clinical challenge, with congenital heart disease alone affecting 36,000 new-borns annually within the European Union. Surgical intervention to restore normal function includes the implantation of synthetic and biological materials; however, a lack of experimental data describing the mechanical behaviour of neonatal cardiac tissue is likely to contribute to the relatively poor short- and long-term outcome of these implants. This study focused on characterising the mechanical behaviour of neonatal cardiac tissue using a porcine model, to enhance the understanding of how this differs to the equivalent mature tissue. The biomechanical properties of neonatal porcine cardiac tissue were characterised by uniaxial tensile, biaxial tensile, and simple shear loading modes, using samples collected from the anterior and posterior walls of the right and left ventricles. Histological images were prepared using Masson’s trichrome staining, to enable assessment of the microstructure and correlation with tissue behaviour. The mechanical tests demonstrated that the neonatal cardiac tissue is non–linear, anisotropic, viscoelastic and heterogeneous. Our data provide a baseline describing the biomechanical behaviour of immature porcine cardiac tissue. Comparison with published data also indicated that the neonatal porcine cardiac tissue exhibits one-half the stiffness of mature porcine tissue in uniaxial extension testing, one-third in biaxial extension testing, and one-fourth stiffness in simple shear testing; hence, it provides an indication as to the relative change in characteristics associated with tissue maturation. These data may prove valuable to researchers investigating neonatal cardiac mechanics.
Lillitos PJ, Lyttle MD, Roland D, et al., 2018, Defining significant childhood illness and injury in the Emergency Department: a consensus of UK and Ireland expert opinion, Emergency Medicine Journal, Vol: 35, Pages: 685-690, ISSN: 1472-0205
Background Clarifying whether paediatric early warning scores (PEWS) accurately predict significant illness is a research priority for UK and Ireland paediatric emergency medicine (EM). However, a standardised list of significant conditions to benchmark these scores does not exist.Objectives To establish standardised significant illness endpoints for use in determining the performance accuracy of PEWS and safety systems in emergency departments (ED), using a consensus of expert opinion in the UK and Ireland.Design Between July 2017 and February 2018, three online Delphi rounds established a consensus on ‘significant’ clinical conditions, derived from a list of common childhood illness/injury ED presentations. Conditions warranting acute hospital admission in the opinion of the respondent were defined as ‘significant’, using a 5-point Likert scale. The consensus was a priori ≥80% (positive or negative). 258 clinical conditions were tested.Participants and settings Eligible participants were consultants in acute or EM paediatrics, or adult EM, accessed via 53 PERUKI (Paediatric Emergency Research in the UK and Ireland)’s research collaborative sites, and 27 GAPRUKI (General and Adolescent Paediatric Research in the UK and Ireland)’s sites, 17 of which overlap with PERUKI.Main outcome measures To create a list of conditions regarded as ‘significant’with ≥80% expert consensus.Results 43 (68%) of 63 PERUKI and GAPRUKI sites responded; 295 experts were invited to participate. Participants in rounds 1, 2 and 3 were 223 (76%), 177 (60%) and 148 (50%), respectively; 154 conditions reached positive consensus as ‘significant’; 1 condition reached a negative consensus (uncomplicated Henoch-Schönlein purpura); and 37 conditions achieved non-consensus.Conclusions A list of significant childhood conditions has been created using UK and Irish expert consensus, for research purposes, for the first time. Th
Vassallo J, Nutbeam T, Rickard AC, et al., 2018, Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation, EMERGENCY MEDICINE JOURNAL, Vol: 35, Pages: 669-674, ISSN: 1472-0205
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