G116(P) Neonatal airway practices: survey of all UK level 3 neonatal services

Aims Management of the neonatal airway can at times be difficult with potentially quick clinical deterioration seen with suboptimal airway management. Fatal consequences can occur if in a cant intubate cant ventilate clinical scenario. There are no standardised guidelines for advanced neonatal airway management. The Difficult Airway Society has algorithms for adult and paediatric practice but not neonatal airway management. We devised a telephone questionnaire to evaluate current neonatal airway management and adjuncts used, in tertiary neonatal units in the UK. Methods UK Level 3 neonatal intensive care units (NICU) were identified using the British Association of Perinatal Medicine website (England and Scotland) with equivalent tertiary centres in Wales and Northern Ireland included. A telephone survey using a structured questionnaire was performed between May and June 2013. Results All 60 NICUs participated in the survey providing complete datasets. All 60 NICUs used muscle relaxants for elective intubations. 35 units (58%) used colour change capnography for endotracheal tube (ETT) placement confirmation. 18 units (30%) used them routinely at every intubation. For units not using capnography routinely, reasons for capnography utilisation included oxygen saturations and heart rate not improving post intubation and general lack of confidence in ETT position. 31 units (58%) limited the number of intubation attempts made by practitioners. 30 units (50%) stated that orophayrngeal airways were routinely used in airway management on the NNU. 40 units (67%) had an emergency difficult airway kit kept on the NICU. Adjuncts included in this were Bougies, introducers, orophayrngeal airways, laryngeal mask airways, Meconium aspirator, Yankeur suction, Maghills forceps, video laryngoscopes, spare laryngoscopes, spare ETTs, fibreoptic laryngoscope, bronchoscope and tracheostomy kits. Only 4 units (1%) had a documented cant intubate cant ventilate policy. Conclusions A variety of airway practices are present across UK NICUs. Standardised guidelines for advanced neonatal airway management