Publications
341 results found
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
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
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- Citations: 35
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
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- Citations: 34
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
ObjectiveTo estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England.DesignOpportunistic cross-sectional survey.Setting10 emergency departments across England.ParticipantsAdolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013.MeasuresScores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID.FindingsAUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%).ConclusionsThe 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.
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.
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.
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
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- Citations: 36
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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- Citations: 17
Booth A, Moylan A, Hodgson J, et 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
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- Citations: 7
Rickard AC, Vassallo J, Nutbeam T, et 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
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- Citations: 5
Kleinman ME, Perkins GD, Bhanji F, et 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, ISSN: 0300-9572
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- Citations: 23
Kleinman ME, Perkins GD, Bhanji F, et 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, ISSN: 0009-7322
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- Citations: 58
Perkins GD, Olasveengen TM, Maconochie I, et al., 2018, European Resuscitation Council Guidelines for Resuscitation: 2017 update, RESUSCITATION, Vol: 123, Pages: 43-50, ISSN: 0300-9572
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- Citations: 78
Chong S-L, Ong GY-K, Chin WYW, et 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.
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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- Citations: 2
Appelbaum N, Clarke J, Maconochie I, et al., 2017, A model for habitus-adjusted paediatric weight estimation by age and data concerning the validation of this method on a large dataset of English children., Data in Brief, Vol: 16, Pages: 771-774, ISSN: 2352-3409
It is often not possible to weigh children upon arrival at an emergency room before commencing the provision of emergency care. Because drugs for children are prescribed on the basis of age and body weight, estimations of weight are necessitated. Age-based equations have been one of the most commonly used weight estimation strategies historically. Due to the variability of weight for age in children, and variations in body habitus, these methods are inaccurate by design (Young and Korotzer, 2016) [1].
Olasveengen TM, de Caen AR, Mancini ME, et al., 2017, 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary, CIRCULATION, Vol: 136, Pages: E424-E440, ISSN: 0009-7322
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- Citations: 86
Olasveengen TM, de Caen AR, Mancini ME, et al., 2017, 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary, RESUSCITATION, Vol: 121, Pages: 201-214, ISSN: 0300-9572
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- Citations: 70
Perkins GD, Neumar R, Monsieurs KG, et al., 2017, The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future, RESUSCITATION, Vol: 121, Pages: 104-116, ISSN: 0300-9572
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- Citations: 52
Appelbaum N, Clarke J, Maconochie I, et al., 2017, Paediatric weight estimation by age in the digital era: optimising a necessary evil., Resuscitation, Vol: 122, Pages: 29-35, ISSN: 0300-9572
BACKGROUND: Age-based weight estimation methods are regularly used in paediatric emergency medicine despite their well-established inaccuracy. AIM: Determine the potential improvement in accuracy achievable by the use of a new mobile application, based on CDC/WHO weight-for-age centile data, which incorporates a gender assignment, a body habitus assessment, and which is capable of an age-in-months based calculation. METHODS: A theoretical, simulated validation study, comparing the performance of the widely used APLS/EPALS formulae against two contemporary habitus-adjusted methods, and the Helix Weight Estimation Tool. 1,070,743 children from the 2015/2016 UK National Child Measurement Program dataset, aged between 4 and 5 and 11 and 12 years, had age-based weight estimates made by all five methods. RESULTS: Primary outcomes were the percentage of weight estimations within 10%, 20%, and those greater than 20% discrepant from actual weight for each method. Our theoretical, gender-dependent, habitus-adjusted method performed better than all other methods across all error thresholds. The overall number of estimations within 10% was 70.4%, and within 20% was 95.45%. The mean percentage error was -1% compared to actual weight. CONCLUSION: The use of a digital tool incorporating a subjective assessment of body habitus, gender assignment, and the ability to estimate weight based on age-in-months might be able optimise the process of paediatric weight estimation by age, making this practice as safe and accurate as possible for the occasions when weight estimation by age is chosen over length-based methods.
Monsieurs KG, Nolan JP, Bossaert LL, et al., 2017, Executive Summary. Section 1 of the European Resuscitation Council Guidelines for Resuscitation 2015 (vol 19, pg 54, 2015), NOTFALL & RETTUNGSMEDIZIN, Vol: 20, Pages: 538-539, ISSN: 1434-6222
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- Citations: 1
Maconochie IK, 2017, Highlights from this issue, Emergency Medicine Journal, Vol: 34, ISSN: 1472-0205
Bressan S, Lyphout C, Yordanov Y, et al., 2017, Management of pediatric head injury: a survey of EuSEM pediatric emergency section, EUROPEAN JOURNAL OF EMERGENCY MEDICINE, Vol: 24, Pages: 308-309, ISSN: 0969-9546
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- Citations: 4
Lopez-Herce J, Rodriguez Nunez A, Maconochie I, et al., 2017, Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines, EMERGENCIAS, Vol: 29, Pages: 266-281, ISSN: 1137-6821
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- Citations: 2
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