Gavin D Perkins

Publications of Gavin D Perkins

• Chest compression quality-push hard, push fast, but how deep and how fast?

  Authors: Jasmeet Soar, Gavin D Perkins, Jerry P Nolan

  Critical care medicine. 04/2012; 40(4):1363-4.

• The rise and fall of β-agonists in the treatment of ARDS.

  Authors: Christopher R Bassford, David R Thickett, Gavin D Perkins

  Critical care (London, England). 03/2012; 16(2):208.

• Video-based CPR training - the importance of quality assurance.

  Authors: Naheed Akhtar, Richard A Field, Robin P Davies, Gavin D Perkins

  Resuscitation. 03/2012;

• Effectiveness of the LUCAS device for mechanical chest compression after cardiac arrest: systematic review of experimental, observational and animal studies.

  Authors: Simon Gates, Jessica L Smith, Giok J Ong, Samantha J Brace, Gavin D Perkins

  Heart (British Cardiac Society). 03/2012;

  CONTEXT: The LUCAS mechanical chest compression device may be better than manual chest compression during resuscitation attempts after cardiac arrest. OBJECTIVE: To summarise the evidence about theCONTEXT: The LUCAS mechanical chest compression device may be better than manual chest compression during resuscitation attempts after cardiac arrest. OBJECTIVE: To summarise the evidence about the effectiveness of LUCAS. DATA SOURCES: Searches of 4 electronic databases, reference lists of included studies, review articles, clinical guidelines, and the manufacturer's web site. No language restrictions were applied. Date of last search: September 2011. STUDY SELECTION: All studies, of any design, comparing mechanical chest compression using LUCAS with manual chest compression, with human or animal subjects. Studies published only as abstracts were included. Manikin studies, and case reports or case series, were excluded. DATA EXTRACTION: Data were extracted on study methodology and outcomes, including return of spontaneous circulation, survival, injuries caused by resuscitation, and physiological parameters. RESULTS: 22 papers reporting 16 separate studies were included. There was one randomised trial, nine cohort studies, 2 before/after studies and 4 animal studies. No meta-analyses were performed because of high risk of bias and heterogeneity in the study designs. Animal studies suggested an advantage to LUCAS in terms of physiological parameters, but human studies did not suggest an advantage in ROSC or survival. Existing evidence is low quality because most studies were small and many were poorly reported. CONCLUSIONS: There is insufficient evidence to make any recommendations for clinical practice. Large scale, high quality randomised trials of LUCAS are needed. Studies that have so far been published only as abstracts should be reported fully.

• Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?

  Authors: James N Fullerton, Charlotte L Price, Natalie E Silvey, Samantha J Brace, Gavin D Perkins

  Resuscitation. 01/2012;

  AIM: Physiological track and trigger scores have an established role in enhancing the detection of critical illness in hospitalized patients. Their potential to identify individuals at risk ofAIM: Physiological track and trigger scores have an established role in enhancing the detection of critical illness in hospitalized patients. Their potential to identify individuals at risk of clinical deterioration in the pre-hospital environment is unknown. This study compared the predictive accuracy of the Modified Early Warning Score (MEWS) with current clinical practice. METHODS: A retrospective observational cohort study of consecutive adult (≥16 yrs) emergency department attendances to a single centre over a two-month period. The outcome of interest was the occurrence or not of an adverse event within 24h of admission. Hospital pre-alerting was used as a measure of current critical illness detection and its accuracy compared with MEWS scores calculated from pre-hospital observations. RESULTS: 3504 patients were included in the study. 76 (2.5%) suffered an adverse event within 24h of admission. Paramedics pre-alerted the hospital in 224 cases (7.3%). Clinical judgement demonstrated a sensitivity of 61.8% (95% CI 51.0-72.8%) with a specificity of 94.1% (95% CI 93.2-94.9%). MEWS was a good predictor of adverse outcomes and hence critical illness detection (AUC 0.799, 95% CI 0.738-0.856). Combination systems of MEWS and clinical judgement may be effective MEWS ≥4+clinical judgement: sensitivity 72.4% (95% CI 62.5-82.7%), specificity 84.8% (95% CI 83.52-86.1%). CONCLUSIONS: Clinical judgement alone has a low sensitivity for critical illness in the pre-hospital environment. The addition of MEWS improves detection at the expense of reduced specificity. The optimal scoring system to be employed in this setting is yet to be elucidated.

• Accuracy of LightCycler(R) SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review protocol.

  Authors: Paul Dark, Claire Wilson, Bronagh Blackwood, Danny F McAuley, Gavin D Perkins, Ronan McMullan, Simon Gates, Geoffrey Warhurst

  BMJ open. 01/2012; 2(1):e000392.

  Background There is growing interest in the potential utility of molecular diagnostics in improving the detection of life-threatening infection (sepsis). LightCycler® SeptiFast is a multipathogenBackground There is growing interest in the potential utility of molecular diagnostics in improving the detection of life-threatening infection (sepsis). LightCycler® SeptiFast is a multipathogen probe-based real-time PCR system targeting DNA sequences of bacteria and fungi present in blood samples within a few hours. We report here the protocol of the first systematic review of published clinical diagnostic accuracy studies of this technology when compared with blood culture in the setting of suspected sepsis. Methods/design Data sources: the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), The Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, BIOSIS Previews, MEDION and the Aggressive Research Intelligence Facility Database (ARIF). Study selection: diagnostic accuracy studies that compare the real-time PCR technology with standard culture results performed on a patient's blood sample during the management of sepsis. Data extraction: three reviewers, working independently, will determine the level of evidence, methodological quality and a standard data set relating to demographics and diagnostic accuracy metrics for each study. Statistical analysis/data synthesis: heterogeneity of studies will be investigated using a coupled forest plot of sensitivity and specificity and a scatter plot in Receiver Operator Characteristic (ROC) space. Bivariate model method will be used to estimate summary sensitivity and specificity. The authors will investigate reporting biases using funnel plots based on effective sample size and regression tests of asymmetry. Subgroup analyses are planned for adults, children and infection setting (hospital vs community) if sufficient data are uncovered. Dissemination Recommendations will be made to the Department of Health (as part of an open-access HTA report) as to whether the real-time PCR technology has sufficient clinical diagnostic accuracy potential to move forward to efficacy testing during the provision of routine clinical care. Registration PROSPERO-NIHR Prospective Register of Systematic Reviews (CRD42011001289).

• Quality of in-hospital cardiac arrest calls: a prospective observational study.

  Authors: Naheed Akhtar, Richard A Field, Liz Greenwood, Robin P Davies, Sarah Woolley, Matthew W Cooke, Gavin D Perkins

  BMJ quality & safety. 12/2011; 21(3):184-90.

  Objective To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. Design Prospective observational study. Setting Three National Health Service acute hospitalsObjective To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. Design Prospective observational study. Setting Three National Health Service acute hospitals in England. Participants Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which required activation of the hospital resuscitation team between 1 December 2009 and 30 April 2010. Main outcome measures Emergency call duration, emergency team dispatch time, diagnostic accuracy of emergency call (sensitivity/specificity), thematic analysis of emergency call, patient outcomes (return of spontaneous circulation and survival to hospital discharge). Results There were 426 adult resuscitation team activations. There was variability in emergency call duration ranging from 6 to 92 s (median 15 s; IQR 12-19). The sensitivity and specificity of calls for a CA was 91% (86.4-94.6%) and 62% (55.5-68.7%), respectively. Sensitivity did not change with call duration but specificity increased from 38% (25.8-51.0%) for the shortest calls to 82% (69.5-89.6%) for longer calls; p=0.03. The return of spontaneous circulation rate was 38% for calls when the patient was confirmed as in CA upon arrival of the resuscitation team. Survival to hospital discharge rates was higher in patients with shorter call durations (26%) than calls with longer call duration (12%); p=0.028. Five themes emerged identifying reasons for the increased call delay. Conclusion There is variability in duration and diagnostic accuracy of in-hospital emergency calls. This is associated with delayed activation of the emergency response. The attempt to differentiate between ME and CA is a source of confusion. A single clinical emergency response for CA and ME calls may provide a more focused and timely emergency response.

• Effect of intravenous β-2 agonist treatment on clinical outcomes in acute respiratory distress syndrome (BALTI-2): a multicentre, randomised controlled trial.

  Authors: Fang Gao Smith, Gavin D Perkins, Simon Gates, Duncan Young, Daniel F McAuley, William Tunnicliffe, Zahid Khan, Sarah E Lamb

  Lancet. 12/2011; 379(9812):229-35.

  In a previous randomised controlled phase 2 trial, intravenous infusion of salbutamol for up to 7 days in patients with acute respiratory distress syndrome (ARDS) reduced extravascular lung water andIn a previous randomised controlled phase 2 trial, intravenous infusion of salbutamol for up to 7 days in patients with acute respiratory distress syndrome (ARDS) reduced extravascular lung water and plateau airway pressure. We assessed the effects of this intervention on mortality in patients with ARDS. We did a multicentre, placebo-controlled, parallel-group, randomised trial at 46 UK intensive-care units between December, 2006, and March, 2010. Intubated and mechanically ventilated patients (aged ≥16 years) within 72 h of ARDS onset were randomly assigned to receive either salbutamol (15 μg/kg ideal bodyweight per h) or placebo for up to 7 days. Randomisation was done by a central telephone or web-based randomisation service with minmisation by centre, pressure of arterial oxygen to fractional inspired oxygen concentration (PaO(2)/F(I)O(2)) ratio, and age. All participants, caregivers, and investigators were masked to group allocation. The primary outcome was death within 28 days of randomisation. Analysis was by intention-to-treat. This trial is registered, ISRCTN38366450 and EudraCT number 2006-002647-86. We randomly assigned 162 patients to the salbutamol group and 164 to the placebo group. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality (55 [34%] of 161 patients died in the salbutamol group vs 38 (23%) of 163 in the placebo group; risk ratio [RR] 1·47, 95% CI 1·03-2·08). Treatment with intravenous salbutamol early in the course of ARDS was poorly tolerated. Treatment is unlikely to be beneficial, and could worsen outcomes. Routine use of β-2 agonist treatment in ventilated patients with this disorder cannot be recommended. UK Medical Research Council, UK Department of Health, UK Intensive Care Foundation.

• Epidemiology and outcome of cardiac arrests reported in the lay-press: an observational study.

  Authors: Richard A Field, Jasmeet Soar, Jerry P Nolan, Gavin D Perkins

  Journal of the Royal Society of Medicine. 12/2011; 104(12):525-31.

  The aims of this study were to evaluate the frequency with which cardiac arrests are reported in newspapers, assess the level of detail reported and ascertain whether this coverage gives a realisticThe aims of this study were to evaluate the frequency with which cardiac arrests are reported in newspapers, assess the level of detail reported and ascertain whether this coverage gives a realistic portrayal of cardiac arrest outcomes to the lay-reader. Observational study. All UK newspaper articles published between 1 January 2010 and 30 June 2010. Articles containing the words 'cardiac arrest', 'CPR' or 'resuscitation' were screen for eligibility. Any articles not involving reference to a real cardiac arrest were excluded. Data relating to patient demographics, arrest characteristics, treatment (CPR and defibrillation) and survival using the Utstein template were extracted. The results were then compared with cardiac arrest statistics from epidemiological studies. Six hundred and forty-eight articles were reviewed, 203 of which referred to individual cardiac arrest events; 22 events occurred in-hospital and 181 occurred out-of-hospital. In the out-of-hospital cardiac arrest (OHCA) group 32 (17.7%) were reported to survive to hospital discharge, almost all with good neurological outcome. The median age group was 31-45-year-olds, 52 (28.7%) were women and 40 were children. Seventy-five percent of victims received bystander CPR with 13 being attended to by lay-responders using AEDs, eight of which presented with a shockable rhythm of which six made a full recovery. Survival to hospital discharge rate among newspaper reports was double that of complete epidemiological studies of OHCAs in urban environments. Newspapers may give readers an over-optimistic portrayal of cardiac arrest survival and neurological outcome following successful resuscitation.

• Variability in cardiac arrest survival: the NHS Ambulance Service Quality Indicators.

  Authors: Gavin D Perkins, Matthew W Cooke

  Emergency medicine journal : EMJ. 11/2011; 29(1):3-5.

• Out-of-hospital cardiac arrest: recent advances in resuscitation and effects on outcome.

  Authors: Gavin D Perkins, Samantha J Brace, Mike Smythe, Giok Ong, Simon Gates

  Heart (British Cardiac Society). 11/2011;

  Successful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonarySuccessful treatment of out-of-hospital cardiac arrest remains an unmet health need. Key elements of treatment comprise early recognition of cardiac arrest, prompt and effective cardiopulmonary resuscitation (CPR), effective defibrillation strategies and organised post-resuscitation care. The initiation of bystander CPR followed by a prompt emergency response that delivers high quality CPR is critical to outcomes. The integration of additional tasks such as defibrillation, airway management, vascular access and drug administration should avoid interruptions in chest compressions. Evidence for the routine use of CPR prompt/feedback devices, mechanical chest compression devices and pharmacological therapy is limited.

• Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1).

  Authors: Moronke A Noah, Giles J Peek, Simon J Finney, Mark J Griffiths, David A Harrison, Richard Grieve, M Zia Sadique, Jasjeet S Sekhon, Daniel F McAuley, Richard K Firmin [......] Susanna Price, Alain Vuylsteke, David P Jenkins, David W Noble, Roxanna Bloomfield, Timothy S Walsh, Gavin D Perkins, David Menon, Bruce L Taylor, Kathryn M Rowan

  JAMA : the journal of the American Medical Association. 10/2011; 306(15):1659-68.

  Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treatExtracorporeal membrane oxygenation (ECMO) can support gas exchange in patients with severe acute respiratory distress syndrome (ARDS), but its role has remained controversial. ECMO was used to treat patients with ARDS during the 2009 influenza A(H1N1) pandemic. To compare the hospital mortality of patients with H1N1-related ARDS referred, accepted, and transferred for ECMO with matched patients who were not referred for ECMO. A cohort study in which ECMO-referred patients were defined as all patients with H1N1-related ARDS who were referred, accepted, and transferred to 1 of the 4 adult ECMO centers in the United Kingdom during the H1N1 pandemic in winter 2009-2010. The ECMO-referred patients and the non-ECMO-referred patients were matched using data from a concurrent, longitudinal cohort study (Swine Flu Triage study) of critically ill patients with suspected or confirmed H1N1. Detailed demographic, physiological, and comorbidity data were used in 3 different matching techniques (individual matching, propensity score matching, and GenMatch matching). Survival to hospital discharge analyzed according to the intention-to-treat principle. Of 80 ECMO-referred patients, 69 received ECMO (86.3%) and 22 died (27.5%) prior to discharge from the hospital. From a pool of 1756 patients, there were 59 matched pairs of ECMO-referred patients and non-ECMO-referred patients identified using individual matching, 75 matched pairs identified using propensity score matching, and 75 matched pairs identified using GenMatch matching. The hospital mortality rate was 23.7% for ECMO-referred patients vs 52.5% for non-ECMO-referred patients (relative risk [RR], 0.45 [95% CI, 0.26-0.79]; P = .006) when individual matching was used; 24.0% vs 46.7%, respectively (RR, 0.51 [95% CI, 0.31-0.81]; P = .008) when propensity score matching was used; and 24.0% vs 50.7%, respectively (RR, 0.47 [95% CI, 0.31-0.72]; P = .001) when GenMatch matching was used. The results were robust to sensitivity analyses, including amending the inclusion criteria and restricting the location where the non-ECMO-referred patients were treated. For patients with H1N1-related ARDS, referral and transfer to an ECMO center was associated with lower hospital mortality compared with matched non-ECMO-referred patients.

• Reply letter: Rescue and Resuscitation or Body Retrieval.

  Authors: Gavin D Perkins

  Resuscitation. 10/2011;

• Pro: β-agonists in acute lung injury--the end of the story?

  Authors: Gavin D Perkins, Daniel F McAuley

  American journal of respiratory and critical care medicine. 09/2011; 184(5):503-4.

• Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality improvement.

  Authors: Federico Semeraro, Luca Marchetti, Antonio Frisoli, Erga L Cerchiari, Gavin D Perkins

  Resuscitation. 09/2011; 83(1):e11-2.

  Download

• The impact of chest compression rates on quality of chest compressions - A manikin study.

  Authors: Richard A Field, Jasmeet Soar, Robin P Davies, Naheed Akhtar, Gavin D Perkins

  Resuscitation. 07/2011; 83(3):360-4.

  Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth,Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables. Twenty healthcare professionals performed 2min of continuous compressions on an instrumented manikin at rates of 80, 100, 120, 140 and 160min(-1) in a random order. An electronic metronome was used to guide compression rate. Compression data were analysed by repeated measures ANOVA and are presented as mean (SD). Non-parametric data was analysed by Friedman test. At faster compression rates there were significant improvements in the number of compressions delivered (160(2) at 80min(-1) vs. 312(13) compressions at 160min(-1), P<0.001); and compression duty-cycle (43(6)% at 80min(-1) vs. 50(7)% at 160min(-1), P<0.001). This was at the cost of a significant reduction in compression depth (39.5(10)mm at 80min(-1) vs. 34.5(11)mm at 160min(-1), P<0.001); and earlier decay in compression quality (median decay point 120s at 80min(-1) vs. 40s at 160min(-1), P<0.001). Additionally not all participants achieved the target rate (100% at 80min(-1) vs. 70% at 160min(-1)). Rates above 120min(-1) had the greatest impact on reducing chest compression quality. For Guidelines 2005 trained rescuers, a chest compression rate of 100-120min(-1) for 2min is feasible whilst maintaining adequate chest compression quality in terms of depth, duty-cycle, leaning, and decay in compression performance. Further studies are needed to assess the impact of the Guidelines 2010 recommendation for deeper and faster chest compressions.

• Rescue and resuscitation or body retrieval--the dilemmas of search and rescue efforts in drowning incidents.

  Authors: Gavin D Perkins

  Resuscitation. 07/2011; 82(7):799-800.

• Delivering high-quality cardiopulmonary resuscitation in-hospital.

  Authors: Jasmeet Soar, Dana P Edelson, Gavin D Perkins

  Current opinion in critical care. 06/2011; 17(3):225-30.

  This review discusses recent data relating to delivering high-quality cardiopulmonary resuscitation (CPR) to patients with in-hospital cardiac arrest. Delivering high-quality CPR requiresThis review discusses recent data relating to delivering high-quality cardiopulmonary resuscitation (CPR) to patients with in-hospital cardiac arrest. Delivering high-quality CPR requires interventions at a national, local, team and individual rescuer level. These include measuring patient outcomes, patient safety incident reporting, education, an increased emphasis on human factors, briefing and debriefing of resuscitation teams, and the use of sensing devices that provide real-time prompts or feedback to rescuers during CPR. Data from national registries, patient safety incident reports and mock codes can be used to identify areas for improving practice. Education of staff is essential in both technical and nontechnical resuscitation skills (human factors). Resuscitation team performance can be improved by ensuring teams brief and plan beforehand and also debrief using feedback data collected during resuscitation events. The use of feedback and prompt devices helps improve adherence to guidelines for chest compression quality but data are lacking in terms of showing improved patient outcomes. Delivering high-quality CPR in-hospital requires a multifaceted approach. Collecting data during arrests and feeding back in real time and postevent during debriefings can be used to improve delivery of high-quality CPR. There are few studies that show improvement in actual patient outcomes (e.g., survival to hospital discharge) with improvements in delivery of high-quality CPR. Recognizing the importance of both technical and nontechnical skills (human factors) to deliver high-quality CPR is essential.

• Self-directed learning: does it affect team performance?

  Authors: Mike Smyth, Gavin D Perkins

  Resuscitation. 03/2011; 82(3):241-2.

• The Beta Agonist Lung Injury TrIal (BALTI)--prevention trial protocol.

  Authors: Gavin D Perkins, Daniel Park, Derek Alderson, Matthew W Cooke, Fang Gao, Simon Gates, Sarah E Lamb, Dipesh Mistry, David R Thickett

  Trials. 03/2011; 12:79.

  BACKGROUND: Acute lung injury complicates approximately 25-30% of subjects undergoing oesophagectomy. Experimental studies suggest that treatment with beta agonists may prevent the development ofBACKGROUND: Acute lung injury complicates approximately 25-30% of subjects undergoing oesophagectomy. Experimental studies suggest that treatment with beta agonists may prevent the development of acute lung injury by decreasing inflammatory cell infiltration, activation and inflammatory cytokine release, enhancing basal alveolar fluid clearance and improving alveolar capillary barrier function. METHODS/DESIGN: The Beta Agonist Lung Injury TrIal (prevention) is a multi-centre, randomised, double blind, placebo-controlled trial. The aim of the trial is to determine in patients undergoing elective transthoracic oesphagectomy, if treatment with inhaled salmeterol 100 mcg twice daily started at induction of anaesthesia and continued for 72 hours thereafter compared to placebo affect the incidence of early acute lung injury and other clinical, resource and patient focused outcomes. The primary outcome will be the development of acute lung injury within 72 hours of oesophagectomy. The trial secondary outcomes are the development of acute lung injury during the first 28 days post operatively; PaO2: FiO2 ratio; the number of ventilator and organ failure free days, 28 and 90 day survival; health related quality of life and resource utilisation. The study aims to recruit 360 patients from 10 UK centres. TRIAL REGISTRATION NUMBER: Current Controlled Trials ISRCTN47481946.