Imperial College London

DrIanMaconochie

Faculty of MedicineSchool of Public Health

Professor of Practice (Paediatric Emergency Medicine)
 
 
 
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Contact

 

+44 (0)20 3312 3729i.maconochie

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

230 results found

Wang X, Nijman R, Camuzeaux S, Sands C, Jackson H, Kaforou M, Emonts M, Herberg J, Maconochie I, Carrol E, Paulus S, Zenz W, Coin L, Flier MVD, Groot RD, Martinon-Torres F, Schlapbach LJ, Pollard A, Fink C, Kuijpers TT, Anderson S, Lewis M, Levin M, McClure Met al., Plasma lipid profiles discriminate bacterial from viral infection in febrile children, Scientific Reports, ISSN: 2045-2322

Journal article

Yao SHW, Ong GY-K, Maconochie IK, Lee KP, Chong S-Let al., 2019, Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections., Emerg Med J

OBJECTIVE: Febrile infants≤3 months old constitute a vulnerable group at risk of serious infections (SI). We aimed to (1) study the test performance of two clinical assessment tools-the National Institute for Health and Care Excellence (NICE) Traffic Light System and Severity Index Score (SIS) in predicting SI among all febrile young infants and (2) evaluate the performance of three low-risk criteria-the Rochester Criteria (RC), Philadelphia Criteria (PC) and Boston Criteria (BC) among well-looking febrile infants. METHODS: A retrospective validation study was conducted. Serious illness included both bacterial and serious viral illness such as meningitis and encephalitis. We included febrile infants≤3 months old presenting to a paediatric emergency department in Singapore between March 2015 and February 2016. Infants were assigned to high-risk and low-risk groups for SI according to each of the five tools. We compared the performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria-RC, PC and BC-among well-looking infants. We presented their performance using sensitivity, specificity, positive, negative predictive values and likelihood ratios. RESULTS: Of 1057 infants analysed, 326 (30.8%) were diagnosed with SI. The NICE guideline had an overall sensitivity of 93.3% (95% CI 90.0 to 95.7), while the SIS had a sensitivity of 79.1% (95% CI 74.3 to 83.4). The incidence of SI was similar among infants who were well-looking and those who were not. Among the low-risk criteria, the RC performed with the highest sensitivity in infants aged 0-28 days (98.2%, 95% CI 90.3% to 100.0%) and 29-60 days (92.4%, 95% CI 86.0% to 96.5%), while the PC performed best in infants aged 61-90 days (100.0%, 95% CI 95.4% to 100.0%). CONCLUSIONS: The NICE guideline achieved high sensitivity in our study population, and the RC had the highest sensitivity in predicting for SI among well-appearing febrile infants. Pr

Journal article

Feather C, Appelbaum N, Clarke J, Franklin B, Sinha R, Pratt P, Maconochie I, Darzi Aet al., Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, BMJ Open, 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.

Journal article

Bressan S, Titomanlio L, Gomez B, Mintegi S, Gervaix A, Parri N, Da Dalt L, Moll HA, Waisman Y, Maconochie IK, Oostenbrink R, REPEMet al., 2019, Research priorities for European paediatric emergency medicine., Arch Dis Child, Vol: 104, Pages: 869-873

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.

Journal article

Kandasamy J, Theobald PS, Maconochie IK, Jones MDet 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

Journal article

Appelbaum N, Clarke J, Feather C, Dean Franklin B, Sinha R, Pratt P, Maconochie I, Darzi Aet 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>

Working paper

Borensztajn D, Yeung S, Hagedoorn NN, Balode A, von Both U, Carrol ED, Dewez JE, Eleftheriou I, Emonts M, van der Flier M, de Groot R, Herberg JA, Kohlmaier B, Lim E, Maconochie I, Martinón-Torres F, Nijman R, Pokorn M, Strle F, Tsolia M, Wendelin G, Zavadska D, Zenz W, Levin M, Moll HAet 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

Journal article

Moylan A, Maconochie I, 2019, Demand, overcrowding and the pediatric emergency department, CANADIAN MEDICAL ASSOCIATION JOURNAL, Vol: 191, Pages: E625-E626, ISSN: 0820-3946

Journal article

Buick JE, Wallner C, Aickin R, Meaney PA, de Caen A, Maconochie I, Skifvars MB, Welsford M, Atkins D, Bingham R, Couto TB, Guerguerian A-M, Hazinski MF, Layonas E, Nadkarni V, Ng K-C, Nuthall G, Ohshimo S, Ong Y-KG, Reis A, Schexnayder S, Scholefield B, Shimizu N, Tijssen J, Van de Voorde Pet al., 2019, Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis, RESUSCITATION, Vol: 139, Pages: 65-75, ISSN: 0300-9572

Journal article

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.

Journal article

Lavonas EJ, Ohshimo S, Nation K, Van de Voorde P, Nuthall G, Maconochie I, Torabi N, Morrison LJ, DeCaen A, Atkins D, Bingham R, Bittencourt-Couto T, Guergerian A-M, Hazinski M-F, Meaney P, Nadkarni V, Ng K-C, Ong Y-KG, Reis A, Schexnayder S, Shimizu N, Tijssen J, Baker B, Bradley-Ridout Get al., 2019, Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis, RESUSCITATION, Vol: 138, Pages: 114-128, ISSN: 0300-9572

Journal article

Moylan A, Appelbaum N, Clarke J, Feather C, Tairraz AF, Maconochie I, Darzi Aet al., 2019, Assessing the agreement of 5 ideal body weight calculations for selecting medication dosages for children with obesity, JAMA Pediatrics, ISSN: 2168-6203

Journal article

van de Maat J, van de Voort E, Mintegi S, Gervaix A, Nieboer D, Moll H, Oostenbrink R, Research in European Pediatric Emergency Medicine study groupet al., 2019, Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study., Lancet Infect Dis, Vol: 19, Pages: 382-391

BACKGROUND: Prevalence of serious bacterial infections in children in countries in western Europe and the USA is low. Antibiotic stewardship aims at a more rational use of antibiotics but information on the frequency of antibiotic prescription to children in emergency departments is scarce. We aimed to quantify and explain variability in antibiotic prescription in children attending European paediatric emergency departments. METHODS: We did a cross-sectional, observational study of children aged between 1 month and 16 years who presented with fever to one of 28 European emergency departments on one random sampling day per month between Nov 1, 2014, and Feb 28, 2016. The surveyed sites were spread across 11 countries and included 17 academic hospitals with 3000 to up to 80 000 annual visits to their paediatric emergency departments. We determined the proportion of children without comorbidities who received antibiotic prescriptions by country, focus of infection, and type of antibiotic. We then did a detailed analysis of the same population, using a multilevel logistic regression analysis, into the variability in prescriptions across hospitals, focusing particularly on respiratory tract infections and correcting for a combination of result-dependent factors. Random group assignment was done by computer randomisation. FINDINGS: Of 5177 children in total, 617 children had comorbidities. Of the 4560 children without comorbidities, 1454 (32%) received antibiotics. This percentage varied from 19% to 64% across countries. Of these 1454 prescriptions issued, 893 (61%) were second-line antibiotics. Antibiotic prescription for respiratory tract infections, the most common infection type, in children without comorbidities was most variable across countries (15-67% for upper respiratory tract infections and 24-87% for lower respiratory tract infections) and was associated with age (odds ratio [OR] 1·51, 95% CI 1·08-2·13), fever duration (OR 1·45, 1&m

Journal article

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.

Journal article

Coulton S, Alam MF, Boniface S, Deluca P, Donoghue K, Gilvarry E, Kaner E, Lynch E, Maconochie I, McArdle P, McGovern R, Newbury-Birch D, Patton R, Phillips CJ, Phillips T, Rose H, Russell I, Strang J, Drummon Cet 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

Journal article

Soar J, Perkins GD, Maconochie I, Böttiger BW, Deakin CD, Sandroni C, Olasveengen TM, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Bossaert L, Monsieurs KG, Nolan JPet 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.

Journal article

Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, Berg KM, Bingham R, Böttiger BW, Callaway CW, Couper K, Couto TB, de Caen AR, Deakin CD, Drennan IR, Guerguerian A-M, Lavonas EJ, Meaney PA, Nadkarni VM, Neumar RW, Ng K-C, Nicholson TC, Nuthall GA, Ohshimo S, O'Neil BJ, Ong GY-K, Paiva EF, Parr MJ, Reis AG, Reynolds JC, Ristagno G, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Tijssen JA, Van de Voorde P, Wang T-L, Welsford M, Hazinski MF, Nolan JP, Morley PT, ILCOR Collaboratorset 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.

Journal article

Ahmad F, Soe S, White N, Johnston R, Khan I, Liao J, Jones M, Prabhu R, Maconochie I, Theobald Pet 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.

Journal article

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

Journal article

Ahmad F, Prabhu R, Liao J, Soe S, Jones MD, Miller J, Berthelson P, Enge D, Copeland KM, Shaabeth S, Johnston R, Maconochie I, Theobald PSet 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.

Journal article

Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, Berg KM, Bingham R, Böttiger BW, Callaway CW, Couper K, Couto TB, de Caen AR, Deakin CD, Drennan IR, Guerguerian A-M, Lavonas EJ, Meaney PA, Nadkarni VM, Neumar RW, Ng K-C, Nicholson TC, Nuthall GA, Ohshimo S, O'Neil BJ, Ong GY-K, Paiva EF, Parr MJ, Reis AG, Reynolds JC, Ristagno G, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Tijssen JA, Van de Voorde P, Wang T-L, Welsford M, Hazinski MF, Nolan JP, Morley PT, ILCOR Collaboratorset al., 2018, 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary., Resuscitation, Vol: 133, Pages: 194-206

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.

Journal article

Lillitos PJ, Lyttle MD, Roland D, Powell CVE, Sandell J, Rowland AG, Chapman SM, Maconochie IKet 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

Journal article

Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, Smith JE, PERUKI Paediatric Emergency Research in the UK and Irelandet al., 2018, Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation., Emerg Med J, Vol: 35, Pages: 669-674

INTRODUCTION: Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation. The aim of this study was, by a process of consensus, to develop an algorithm for the management of paediatric TCA for adoption in the UK. METHODS: A modified consensus development meeting of UK experts involved in the management of paediatric TCA was held. Statements discussed at the meeting were drawn from those that did not reach consensus (positive/negative) from a linked three-round online Delphi study. 19 statements relating to the diagnosis, management and futility of paediatric TCA were initially discussed in small groups before each participant anonymously recorded their agreement with the statement using 'yes', 'no' or 'don't know'. In keeping with our Delphi study, consensus was set a priori at 70%. Statements reaching consensus were included in the proposed algorithm. RESULTS: 41 participants attended the meeting. Of the 19 statements discussed, 13 reached positive consensus and were included in the algorithm. A single statement regarding initial rescue breaths reached negative consensus and was excluded. Consensus was not reached for five statements, including the use of vasopressors and thoracotomy for haemorrhage control in blunt trauma. CONCLUSION: In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first consensus-based algorithm specific to the paediatric population. While this algorithm was developed for adoption in the UK, it may be applicable to similar healthcare systems interna

Journal article

Booth A, Moylan A, Hodgson J, Wright K, Langworthy K, Shimizu N, Maconochie Iet al., 2018, Resuscitation registers: How many active registers are there and how many collect data on paediatric cardiac arrests?, RESUSCITATION, Vol: 129, Pages: 70-75, ISSN: 0300-9572

Journal article

Rickard AC, Vassallo J, Nutbeam T, Lyttle MD, Maconochie IK, Enki DG, Smith JEet al., 2018, Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management, EMERGENCY MEDICINE JOURNAL, Vol: 35, Pages: 434-439, ISSN: 1472-0205

Journal article

Kleinman ME, Perkins GD, Bhanji F, Billi JE, Bray JE, Callaway CW, de Caen A, Finn JC, Hazinski MF, Lim SH, Maconochie I, Morley P, Nadkarni V, Neumar RW, Nikolaou N, Nolan JP, Reis A, Sierra AF, Singletary EM, Soar J, Stanton D, Travers A, Welsford M, Zideman Det al., 2018, ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement., Resuscitation, Vol: 127, Pages: 132-146

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

Journal article

Kleinman ME, Perkins GD, Bhanji F, Billi JE, Bray JE, Callaway CW, de Caen A, Finn JC, Hazinski MF, Lim SH, Maconochie I, Nadkarni V, Neumar RW, Nikolaou N, Nolan JP, Reis A, Sierra AF, Singletary EM, Soar J, Stanton D, Travers A, Welsford M, Zideman Det al., 2018, ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement., Circulation, Vol: 137, Pages: e802-e819

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines.

Journal article

Perkins GD, Olasveengen TM, Maconochie I, Soar J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Monsieurs KG, Nolan JP, European Resuscitation Councilet al., 2018, European Resuscitation Council Guidelines for Resuscitation: 2017 update., Resuscitation, Vol: 123, Pages: 43-50

Journal article

Chong S-L, Ong GY-K, Chin WYW, Chua JM, Nair P, Ong ASZ, Ng KC, Maconochie Iet al., 2018, A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department., PLoS ONE, Vol: 13, ISSN: 1932-6203

OBJECTIVES: Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). MATERIALS AND METHODS: We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED. We documented the primary outcome of SI for each infant, as well as the clinical findings, vital signs, and Severity Index Score (SIS). We assessed the performance of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS), Advanced Pediatric Life Support (APLS) guidelines and Fleming normal reference values, using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristics curve (AUC). RESULTS: 1057 infants were analyzed, with 326 (30.6%) infants diagnosed with SI. High temperature, tachycardia, and low SIS score were significantly associated with SI. Item analysis showed that the SIS performance was driven by the presence of mottling (p = 0.003) and high temperature (p<0.001). The APLS guideline had the highest sensitivity (66.0%, 95% CI 60.5-71.1%), NPV (73.3%, 95% CI 69.7-76.5%) and AUC (0.538), while the PaedCTAS (2 standard deviation from normal) had the highest specificity (98.5%, 95% CI 97.3-99.3%) and PPV (55.2%, 95% CI 32.7-71.0%). CONCLUSIONS: Current guidelines on infantile heart rates have a variable performance. In our study, the APLS heart rate guidelines performed with the highest sensitivity, but no individual guideline predicted for SIs satisfactorily.

Journal article

Maconochie I, de Caen A, 2018, When should ADULT CPR be delivered to children?, RESUSCITATION, Vol: 122, Pages: A4-A5, ISSN: 0300-9572

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