Description of impact
Britta is a highly experienced clinical trialist with an outstanding track record of impactful research and has led many clinical trials both nationally and internationally involving tens of thousands of children. She is a pioneer in the area of respiratory complications, the most common paediatric perioperative problem, and her patient-centred research has led to significant global practice changes and a reduction in complications around the world. Britta’s outstanding achievements include:• Improving the understanding of the physiological changes during paediatric anaesthesia. Britta has conducted several studies on this topic, key to guiding appropriate anaesthetic management. Her Lancet article (PMID: 20816545; DOI: 10.1016/S0140-6736(10)61193-2) identified the associations between family history, anaesthesia management and the occurrence of respiratory problems during and after surgery. This prospective cohort study of more than 9000 children showed that those at high risk of breathing problems could be prospectively identified during pre-anaesthesia assessment and was first to identify risk factors and impacts of different techniques. The use of these risk factors by anaesthetists allows better planning and targeted anaesthesia management.
• Clarifying risks and appropriate management strategies for high-risk groups e.g. infants. An example of this is her research on ETTs vs LMA for infants (PMID: 28108038; DOI: 10.1016/S0140-6736(16)31719-6) . Both ETTs (endotracheal tubes) and LMAs (laryngeal mask airways) are devices used to secure a patient’s airway for anaesthesia. Before this research intubation was standard practice for young infants. Britta and her team were able to show that the use of LMA was associated with fewer respiratory problems during and after surgery. This paper changed clinical practice as it showed that LMA use was safer for young infants of less than 12 months. Britta was also first to demonstrate that over-the-counter asthma treatment Salbutamol (Ventolin) significantly decreased respiratory complications, particularly in highest risk children (JAMA Pediatrics 2019 PMID31009034). Her world-first randomised, triple-blind, placebo-controlled trial of tonsillectomy patients showed those receiving a placebo were three times more likely to have breathing problems than those on Salbutamol. This practice is now incorporated in global clinical guidelines (e.g. www.awmf.org, https://pedsanesthesia.org, www.asahq.org). This outcome is important, not only as it improves safety for children, but because it is a low-cost, readily available, easily implementable safety measure which can be used in resource-poor countries.
• Providing reassuring evidence as part of the GAS consortium for parents and clinicians about the safety of general anaesthesia for babies and infants. For some time, there has been discussion and controversy around the safety of anaesthesia for the developing brain. This was fuelled by considerable animal evidence that prolonged exposure to many anaesthetic agents (e.g. Sevoflurane, an inhalation anaesthetic agent for use in induction and maintenance of general anaesthesia) may have impact on neurodevelopment. Britta is working with an international collaboration (the GAS consortium) to investigate the impact of anaesthesia on neurodevelopment. This research into neurodevelopmental effects is a global effort by the research community and Britta is a key partner in this effort. The outcomes have been published in The Lancet (2016 PMID: 26507180) and 2019 (PMID: 30782342) and have provided reassuring evidence that a single, brief (less than 1 h) exposure to general anaesthesia during infancy is not harmful to gross neurodevelopment.
It is well-known that there is a time lag of up to 17 years between research and implementation (Journal of the Royal Society of Medicine PMID:22179294). However, Britta has an impressive record of rapid translation and implementation of her research findings. For example, research results of the RCTs VISI (Lancet 2020, PMID: 33308472) and OPTIMISE (Lancet Child and Adolescent Health 2023, PMID: 36436541) have rapidly incorporated into the Difficult Airway Guidelines of the American Society of Anesthesiology (01/2022, PMID:34762729, VISI only) and in Guidelines of the European Society of Anesthesiology and Intensive Care and British Journal of Anaesthesia (01/2024, PMID:38065762/P38018248). This underlines how Britta is centrally involved in driving and translating critical research, which is clinically relevant, globally important and rapidly implemented in routine care globally. It is testament to the strength and impact of her research program.