Post cardiac Arrest Care in Kids: PACK

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Group lead: Dr Barney Scholefield

Follow the group on Twitter: @BarneyUoB

Overview

A cardiac arrest in an infant of child can be a devastating event with a high risk of death or survival with significant neurodevelopmental injury. Our research aims to investigate the key prognostic factors associated with poor outcomes and test the efficacy of targeted interventions during pre-hospital resuscitation and the post cardiac arrest care phase of treatment within the paediatric intensive care unit.

Our research

The Post Arrest Care in Kids (PACK) Group has a strong focus on improving clinical, patient related outcomes for infants and children affected by paediatric cardiac arrest.

The PACK Group brings together clinical academics and NHS staff managing paediatric cardiac arrests from pre-hospital medicine, paramedic services, paediatric emergency medicine and paediatric critical care with applied health scientists working in prognostic modelling, statistics, biomedical ethics and clinical trials.

Our projects range from observational cohort studies exploring the key early prognostic factors at the time of resuscitation, their association with survival and neurodevelopmental recovery, to interventional trials understanding and investigating the role of novel and established neuro-monitoring devices (e.g. amplitude integrated electroencephalography, pupilometers, MR imaging) and neuroprotective interventions (e.g. targeted temperature management) in the post-cardiac arrest phase in the paediatric intensive care unit.

We also use prognostic modelling research to create bed-side clinical prediction tools to aid clinician’s communication with families after paediatric cardiac arrest. Qualitative research will also improve our understanding of clinical uncertainty and its effect on clinician’s communication of prognosis to families during this extremely challenging clinical scenario.

We collaborate closely with the Paediatric Intensive Care Audit Network (PICANet) database and oversee the PICANet Post Arrest Care in Kids (NET-PACK) Custom Audit study.

Current projects

NEURO-developmental Prognosis After Cardiac arrest in Kids (NEURO-PACK) Observational Study
An NIHR funded project to identify a cohort of patients admitted to paediatric critical care after out-of-hospital and in-hospital cardiac arrest and collect important neurodevelopmental outcomes. This will create a derivation cohort to create a clinical prediction model.

PICANet Post Arrest Care In Kids (NET-PACK 3) Audit
A nationwide custom audit evaluating the impact of International Liaison Committee on Resuscitation (ILCOR) 2015 guidelines on post cardiac arrest targeted temperature management in UK and Irish Paediatric Intensive Care Units.

The Jobe Study: Monitoring brain function after cardiac arrest and traumatic brain injury in children
A single centre observational study collecting high acuity data from novel and established multi-modal neuromonitoring (Pupillometry, MR imaging, amplitude integrated electroencephalography, Four score) and linking with important clinical outcomes.

Pre-hospital Post Arrest Care in Kids (Pre-PACK) Study
Collaborative study with the West Midlands Ambulance Service evaluating and targeting frontline pre-hospital staff quality cardiopulmonary resuscitation and early post arrest care.

 

Publications

Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Browning B, Pemberton VL, Page K, Gildea MR, Scholefield BR, Shankaran S, Hutchison JS, Berger JT, Ofori-Amanfo G, Newth CJ, Topjian A, Bennett KS, Koch JD, Pham N, Chanani NK, Pineda JA, Harrison R, Dalton HJ, Alten J, Schleien CL, Goodman DM, Zimmerman JJ, Bhalala US, Schwarz AJ, Porter MB, Shah S, Fink EL, McQuillen P, Wu T, Skellett S, Thomas NJ, Nowak JE, Baines PB, Pappachan J, Mathur M, Lloyd E, van der Jagt EW, Dobyns EL, Meyer MT, Sanders RC Jr, Clark AE, Dean JM; THAPCA Trial Investigators. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. N Engl J Med. 2017 Jan 26;376(4):318-329. doi: 10.1056/NEJMoa1610493. PubMed PMID: 28118559; PubMed Central PMCID: PMC5310766.

Scholefield BR, Gao F, Duncan HP, Tasker RC, Parslow RC, Draper ES, McShane P, Davies P, Morris KP. Observational study of children admitted to United Kingdom and Republic of Ireland Paediatric Intensive Care Units after out-of-hospital cardiac arrest. Resuscitation. 2015 Dec;97:122-8.

Scholefield BR, Morris KP, Duncan HP, Perkins GD, Gosney J, Skone R, Sanders V, Gao F. Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest. Resuscitation. 2015 Jul;92:19-25

Scholefield BR, Perkins GD, Duncan HP, Gao F, Morris KP. Should children who have a cardiac arrest be treated with therapeutic hypothermia? BMJ. 2014 Jan 16;348:f7672

Scholefield B, Duncan H, Davies P, Gao Smith F, Khan K, Perkins GD, Morris K. Hypothermia for neuroprotection in children after cardiopulmonary arrest. Cochrane Database Syst Rev. 2013 Feb 28;(2):CD009442. doi: 10.1002/14651858.CD009442.pub2. Review. PubMed PMID: 23450604.

Funders

Research Team

Principal Investigator
Dr Barney Scholefield 

PhD Students
TBC 

NHS Staff
Dr Hari Krishnan, Consultant Paediatric Intensivist, Birmingham Children’s Hospital
Mr Will McDevitt, Neurophysiologist, Birmingham Children’s Hospital
Ms Tracey Rowberry, Advanced Nurse Practitioner, Birmingham Children’s Hospital
Mr Jason Wiles, Clinical lead for paediatrics and safeguarding, West Midlands Ambulance Service

Internal Collaborators
Prof Fang Gao-Smith, PACCT Group Lead and Clinical Trialist
Prof Jon Deeks, Prognostic Modelling and statistics
Prof Peter Brocklehurst, Birmingham Clinical Trials Unit 

External Collaborators
Professor Heather Draper, University of Warwick
Professor Gavin Perkins, University of Warwick
Dr Sophie Skellet, Great Ormond Street Hospital, London
Dr Ian Maconochie, St Mary’s Hospital, London
Dr Alexis Topjian, University of Philadelphia
Dr Frank Moler, University of Michigan
Dr Jamie Hutchison, University of Toronto
Prof Mike Dean, University of Utah
Professor Robert Tasker,  Harvard University
Professor Vinay Nadkarni, University of Philadelphia

Funding Bodies

Useful Links

Paediatric Intensive Care Audit Network -  PICANET

Paediatric Critical Care Society - PCCS UK 

Follow the group on  Twitter : @BarneyUoB