Implementation mapping to plan for the Supraglottic Airway for Resuscitation (SUGAR) trial

Area of Science:

• Neonatal Resuscitation
• Implementation Science
• Medical Device Adoption

Background:

• Positive pressure ventilation (PPV) is critical for neonatal resuscitation.
• Supraglottic airway (SA) devices show higher effectiveness than face masks in reducing PPV failure and intubation needs.
• Despite evidence, SA device use is infrequent in US hospital delivery rooms.

Purpose of the Study:

• To identify barriers and facilitators to supraglottic airway (SA) device use in neonatal resuscitation.
• To develop and refine implementation strategies for increasing SA device adoption.
• To inform the design of a pragmatic hybrid effectiveness-implementation trial.

Main Methods:

• Implementation mapping was employed to systematically identify barriers and facilitators.
• The Consolidated Framework for Implementation Research (CFIR) was used to organize findings.
• Iterative feedback from clinicians and administrators refined implementation strategies.

Main Results:

• Key barriers included mixed perceptions of SA devices, insufficient education/training, and lack of perceived need for alternatives.
• Implementation strategies were selected based on identified barriers and facilitators.
• The process led to the selection of two sets of strategies for a hybrid trial.

Conclusions:

• Implementation mapping offers a systematic, partner-engaged approach for selecting strategies in hybrid trial design.
• This process can be an exemplar for other healthcare settings aiming to improve device adoption.
• Addressing identified barriers is crucial for successful integration of effective SA devices into routine practice.