640 - Teaching SALSA (Surfactant Administration through Laryngeal or Supraglottic Airways) Using Neonatal Airway Simulators in Indian NICUs

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 640
Publication Number: 640.316

Kaylee G. Wu, Lipscomb University, Medford, OR, United States; Satish Saluja, Sir Ganga Ram Hospital, New Delhi, India, NEW DELHI, Delhi, India; Gautam Yadav, Kalawati hospital, Rewari, Haryana, India; Avneet Kaur, Apollo Cradle, Delhi, Delhi, India; Harpreet Singh, Child Health Imprints CHIL USA Inc, McFarland, WI, United States; Kari Roberts, Univ of MN, Mpls, MN, United States; Ryan McAdams, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Scott O. Guthrie, Monroe Carell Jr. Children's Hospital at Vanderbilt, Jackson, TN, United States

Presenting Author(s)

Kaylee G. Wu

Undergraduate Student
Lipscomb University
Medford, Oregon, United States

Background: Surfactant administration through laryngeal or supraglottic airways (SALSA) is a simplified procedure for delivering surfactant that is less invasive than endotracheal tube intubation and does not require a provider skilled in laryngoscopy. The use of simplified surfactant administration has the potential to significantly lower neonatal mortality in low and middle-income countries (LMIC) with limited healthcare resources.

Objective:
To teach SALSA using neonatal airway simulators as part of a quality improvement initiative.

Design/Methods:
Neonatal care providers in four Indian NICUs received instruction on SALSA. Instruction included a 30-minute didactic session followed by a demonstration on a neonatal simulator. Providers then performed the procedure on the simulator while their performance was observed, evaluated, and reviewed by the instructor. Upon completion, providers were surveyed to determine their perception of the SALSA procedure. Follow-up with leaders occurred at six months to determine if SALSA had been performed as well as the outcome, perception, and barriers associated with the procedure.

Results:
71 neonatal care providers were trained on the SALSA procedure. Using a procedure flow chart, 100% of those trained were able to place the device on the first attempt and perform the steps to administer surfactant. After receiving the training, 100% responded that they would feel comfortable performing the procedure. Follow-up at 6 months revealed that 13 SALSA procedures had been performed. Surfactant was successfully administered to all neonates, with only one needing a repeat dose. Three NICU leaders responded that their teams of physicians and nurses had the perception that SALSA was easier to perform and/or less stressful for the provider and better tolerated and/or less painful for the baby than intubation. Barriers to having performed a SALSA procedure were identified as: geographical distance limiting regular communication with the team, identifying the right patient for the procedure, and NICU provider resistance to trying something new.

Conclusion(s):
SALSA can be effectively taught and mastered in a short period of time with simulation training and then integrated into clinical care. This simplified procedure for delivery of surfactant without the need for advanced skills could be lifesaving, potentially diminish gaps in care, and may help ensure more equitable global neonatal survival rates. As our initiative progresses, we hope to continue to learn about and address the perceived barriers so that the adoption of SALSA can be easily replicated in other settings.