Association of Anaesthetists/Anaesthesia Research Grants

University Hospitals Birmingham NHS Foundation Trust

Title
ICNAP-1 The First Intensive Care National Audit Project

Amount
£9,769

Scientific Abstract

Background
Central venous catheters are inserted ubiquitously in critical care and have roles in drug
administration, fluid management and renal replacement therapy. They are also associated
with numerous complications. The true number of central venous catheters inserted per year
and the proportion of them associated with complications are unknown in the UK.

Methods
We will set up a network, working with trainee research networks, with a local reporter in each hospital. All CVCs (Central lines & RRT Lines) inserted in theatres or Intensive care (or by the theatres or ICU teams) will be included in the audit. All operators will be asked to fill in a survey detailing their experience, training and competency in CVCs. Data will be collected using the novel secure data collection platform from the Welsh sepsis group.

Results
Results will be collated in a secure server and appropriate data analysis plan will be developed with the help of experienced statisticians

Dissemination of findings
We would aim to publish results in a major UK anaesthesia/Intensive Care journal, and present them at various national & international conferences; with a view to changing guidelines/practice.

Queen Elizabeth Hospital, Birmingham

Title
Evaluation of local anaesthetic spread from serratus anterior plane catheters in patients with anterior, lateral or posterior rib fractures

Amount
£14,000

Scientific Abstract

Background
Despite the increased use of Serratus Anterior Plane (SAP) catheters for rib fracture analgesia, their mechanism of action is not fully understood.

Need for this study
Rib fracture pain originates from the intercostal nerves, yet current studies have seen only occasional involvement of these nerves. It is postulated that respiration, traumatic disruption of the fascial planes and the insertion of catheters increases the spread of local anaesthetic. No study to date has controlled for these factors.

Aims
We hope to answer whether the presence of rib fractures in the anterior, lateral or posterior distribution results in the consistent spread of injectate to the intercostal nerves or paravertebral space, whilst controlling for the effects of ventilation and catheter insertion.

Methodology and Outcomes

• P Fresh Frozen Cadavers (n=6) with SAP catheters inserted at the level of the 4th rib. 15minutes of ventilation would follow injectate administration (20mls 0.25%
  bupivacaine with methylene blue).
  
• I Rib fractures to one hemithorax in the anterior (n=2) lateral (n=2) or posterior (n=2)
  distribution produced by manual compression.
  
• C Opposite hemithorax would remain intact (n=6),
  
• O Cadaveric dissection to confirm injectate spread and nerve involvement

Manchester University Hospitals

Title
Re-exploration of the caesarean section wound (rectus sheath re-opened) or relaparotomy up to 28 days following caesarean section' - A prospective case-control study

Amount
£18,680

Scientific Abstract
Almost 25-30% of women in the United Kingdom (UK) deliver by Caesarean Section (CS) as per hospital episode statistics. Little information is available regarding patients who have a re-exploration or relaparotomy following CS in UK. We aim to determine the incidence of re-exploration and relaparotomy up to 28 days following CS over a period of one year and review the maternal outcomes following this complication. This will be a prospective case-control observational study with data being collected from all consultant-led UK delivery suites facilitated by the UKOSS data collection system. Findings from this study would highlight the main causes of re-exploration following CS, investigations undertaken before the re-exploration, critical care utilisation, systemic and wound infection rates, length of stay in hospital, morbidity, and mortality - some of which could serve as peri-operative medicine quality indicators for obstetric units in UK. Information obtained from this study will identify high-risk patients and facilitate informed consent. Analysis of the investigations undertaken before the re-exploration could highlight which imaging techniques have a positive or negative predictive value. The study will give an opportunity to explore areas, which could improve peripartum care, decrease the length of stay, decrease hospital costs, and improve maternal experience and wellbeing.

North Bristol NHS Trust

Title
How do the cognitive and affective processes interact with the decision to perform an emergency Front of Neck Airway?

Amount
£9,965

Scientific Abstract
The aim of this study is focused on improving the safety of patients undergoing general anaesthesia. Specifically, those suffering the complication of having a "Can't intubate, can't oxygenate" situation, where hypoxic brain damage or death will occur unless an Emergency Front of Neck Airway (FONA) is performed.

There are various barriers to performing this procedure, and whilst training may improve guideline compliance, this does not apply to the critical component of decision making. This decision-making process remains a grossly under-scrutinised area of difficult airway management, and almost no exploratory analysis has been performed looking at the cognitive and psychological barriers to performing FONA.

This study intends to address this knowledge gap by undertaking confidential in-depth focused semi-structured telephone interviews with anaesthetists and intensivists whom have either performed or attempted FONA in the anaesthetic setting within the past 2 years. Data will undergo reflexive qualitative (thematic) analysis, a recognised and robust method of identifying patterned sets of meaning across a dataset.

By developing a greater understanding of any cognitive processes and barriers to performing this life-saving procedure, and by subsequently disseminating this information, we aim to inform strategies to help overcome these.

University of Glasgow

Title
Mortality and long-term morbidity in survivors of burn injuries

Amount
£16,440

Scientific Abstract

Background
Survivors of burn injuries are at risk of developing psychological harm, an increased risk of infectious and cardiovascular complications, as well as premature death. The burden of these consequences is poorly understood and not quantified.

Aims
The purpose of our study is to investigate the long-term consequences of surviving a burn injury and describe the burden of health placed upon these patients.

Methods
This is a retrospective observational cohort study. We will match a cohort of adult burns survivors with two groups. Firstly, a population based group matched to age, gender and social deprivation. Secondly, patients admitted with a diagnosis of acute pancreatitis. Pancreatitis has been chosen as the pathophysiology mirrors that of a burn, with a similar inflammatory response and multiorgan sequalae.

An application will be made to the Public Benefit and Privacy Panel to use linkage of national data sources to explore outcomes including:

• Acute hospital admissions
  
• Psychiatric hospital admissions
  
• Time and cause of death
  
• Drugs prescribed in the community
  
• Use of outpatient resources
  
• Risk of developing cancer

This research will improve our understanding of the long-term consequences of sustaining a burn injury and allow us to focus health care resources in the future.