738 - Implementation and Safety Monitoring of Catheter Based Surfactant Administration at a Level III Neonatal Intensive Care Unit

To implement CBSA and monitor for adverse events at our Level III NICU.

Design/Methods: We created a protocol to implement CBSA at our academic, level III NICU based on existing literature and consultation with other NICUs currently using CBSA. We held training sessions for NICU providers and respiratory therapists, led by a core group of NICU fellows. Tracheal intubation associated events (TIAEs) occurring during CBSA were tracked using the National Airway Emergency Registry for Neonates (NEAR4NEOS); data were collected from 3/2022-12/2022 via a paper data collection form at the time of the procedure and were later entered in the NEAR4NEOS REDCap database.

Results:

During the study period, 43 CBSA procedures were performed. Two encounters required subsequent intubation after CBSA. The mean weight for infants undergoing CBSA was 2070 g (range 975 g-3820 g). Mean birth gestational age was 33 weeks (range 27-39 w). Success on first laryngoscopy attempt during CBSA was 51% (n= 22/43). Video laryngoscopy (C-MAC by Storz) was used for the majority of CBSA attempts (63%, n=27) compared to direct laryngoscopy (37%, n=16). Forty-two percent of CBSA encounters had TIAEs (n=18), as defined by NEAR4NEOS. TIAEs during CBSA encounters included visible surfactant regurgitation (n=6), gum or dental trauma (n=3), respiratory interface mask dislodged (n=3), esophageal catheter placement (n=2), lip trauma (n=2), dysrhythmia (including bradycardia < 60 bpm), procedure paused for facemask PPV, direct airway injury, vomit without aspiration (each n=1). 

Conclusion(s): Implementing CBSA in our level III NICU was feasible. There were adverse events; however most did not impact surfactant delivery. However, generalizability of data from our single center is difficult; as CBSA becomes more prevalent, airway data registries such as NEAR4NEOS will be increasingly helpful in determining safety of the procedure. Ongoing surveillance of TIAEs, as well as continued training and simulation of CBSA, is necessary to ensure safe execution of this procedure.