796 Bridging the DAM gap!!

Abstract

<h3>Background</h3> In many Neonatal clinical emergencies, endotracheal intubation procedure is life saving and forms a vital part of neonatal resuscitation. It is possible that current trainees are getting less exposure to emergency intubations in the current scenario of less invasive methods of neonatal stabilisation and surfactant administration. <h3>Objectives</h3> To explore knowledge and awareness regarding Difficult Airway Management (DAM) in Neonates amongst neonatal practitioners in local deanery and Surrey Heartlands region. <h3>Methods</h3> A web-based questionnaire survey was sent out to junior paediatric doctors, Advanced Neonatal Nurse Practitioners (ANNP) and consultants to determine their experience and understanding of Difficult Airway Management in Neonatal medicine clinical practice. Also assessed was their confidence level on a 1 to 5 scale on neonatal intubation. The responses were analyzed using Excel. <h3>Results</h3> 83 responses were received which were constituted by 17% (14) Senior House Officers, 55.4% (46) Registrars, 18% (15) Consultants and 9.6% (8) ANNP. Those in run through training program were ST1–3 (11), ST4–5(21) and ST6–8 (20). Highest neonatal hospital experience was gained in Tertiary hospital Neonatal unit by 54%(45),in District General Hospital with level 3 neonatal unit by 30% (25), level 2 by 10.8%(9) and the rest in level 1 unit. Previous Neonatal Experience: 33.7% (28) more than 5 y experience, 3–5y experience in 14.4% (12), 31.3% (26) had 1–3 yrs, 6 mo-12 mo by 9.6% (8), 3–6 month experience in 8.4% (7). 3.6% (3) were working for the first time in NICU. Confidence Level on Neonatal Intubation: 47% (39) reported to be very or extremely confident. 31% (26) were somewhat confident and 22% (18) were not so or not at all confident. Nearly half (46%) were not aware of any DAM guidelines, Only 7% (6)were aware of both National and Local Guidelines. 20% (17) knew about National guidelines and 26%(22) were aware of local guidelines. Overall only 10 (21.7%) Registrars and 3 (37.5%) ANNP’S were aware of National Guidelines. Training on DAM: 44.5% (37) had never received any training and were interested to attend training course, 24% (20) had received between 1–3 y and 12% (10) had &gt;3y ago. Out of 45 registrars overall, 21 (47%) have never had a training session. Difficult airway was reported to be encountered by 53% (44) and 5% (4) did not know what is meant by Difficult Airway. Use of airway adjuncts- Supraglottic Airway Device (SAD) and Video Laryngoscope (VL): both not used by 36% (30),10.8% (9)had experience using both only 6% (5) had used SAD, only 29% (24) reported to have used VL, 16% had used each of them in simulation. <h3>Conclusions</h3> There seems to be a wide variation in the knowledge and skills of DAM among neonatal clinicians.Only half of the clinicians who took part in the survey seemed to been aware of any DAM guidelines, only a minority seem to have received formal training in this scenario. We intend to address this locally and regionally by robust training and guidelines by working with the deanery and integrated care systems.