Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

BackgroundInternational neonatal resuscitation guidelines recommend the use of laryngeal mask airway (LMA) with newborn infants (≥34 weeks’ gestation or >2 kg weight) when bag-mask ventilation (BMV) or tracheal intubation is unsuccessful. Previous publications do not allow broad LMA device comparison.ObjectiveTo compare delivered ventilation of seven brands of size 1 LMA devices with two brands of face mask using self-inflating bag (SIB).Design40 experienced neonatal staff provided inflation cycles using SIB with positive end expiratory pressure (PEEP) (5 cmH2O) to a specialised newborn/infant training manikin randomised for each LMA and face mask. All subjects received prior education in LMA insertion and BMV.Results12 415 recorded inflations for LMAs and face masks were analysed. Leak detected was lowest with i-gel brand, with a mean of 5.7% compared with face mask (triangular 42.7, round 35.7) and other LMAs (45.5–65.4) (p<0.001). Peak inspiratory pressure was higher with i-gel, with a mean of 28.9 cmH2O compared with face mask (triangular 22.8, round 25.8) and other LMAs (14.3–22.0) (p<0.001). PEEP was higher with i-gel, with a mean of 5.1 cmH2O compared with face mask (triangular 3.0, round 3.6) and other LMAs (0.6–2.6) (p<0.001). In contrast to other LMAs examined, i-gel had no insertion failures and all users found i-gel easy to use.ConclusionThis study has shown dramatic performance differences in delivered ventilation, mask leak and ease of use among seven different brands of LMA tested in a manikin model. This coupled with no partial or complete insertion failures and ease of use suggests i-gel LMA may have an expanded role with newborn resuscitation as a primary resuscitation device.

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Bag-mask ventilation and direct laryngoscopy versus intubating laryngeal mask airway

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e32836033b3 ◽

2014 ◽

Vol 21 (3) ◽

pp. 189-194 ◽

Cited By ~ 2

Author(s):

Sebastian G. Russo ◽

Christoph Stradtmann ◽

Thomas A. Crozier ◽

Christiane Ringer ◽

Hans-Joachim Helms ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Direct Laryngoscopy ◽

Laryngeal Mask ◽

Mask Ventilation ◽

Intubating Laryngeal Mask Airway ◽

Bag Mask Ventilation

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Proficiency of Laryngeal Mask Airway Insertion Skill in NRP Certified Providers

American Journal of Perinatology ◽

10.1055/s-0040-1721379 ◽

2020 ◽

Author(s):

Srinivasan Mani ◽

Munmun Rawat

Keyword(s):

Laryngeal Mask Airway ◽

Endotracheal Intubation ◽

Simple Procedure ◽

Neonatal Resuscitation ◽

Standard Of Care ◽

Laryngeal Mask ◽

Positive Pressure ◽

Laryngeal Mask Airway Insertion ◽

Chi Square ◽

Aerosol Generation

Objective In 2015, Neonatal Resuscitation Program (NRP) recommended laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) in situations where the provider is “unable to intubate and unable to ventilate.” LMA insertion is being taught in the NRP routinely. However, endotracheal intubation is the primary method considered as the standard of care in neonatal resuscitation. LMA insertion is a relatively simple procedure with an average insertion time of < 10 seconds. Newer generation LMA can have the added advantage of reducing the risk of aerosol generation and improving the safety of the providers. Only a few recent studies have evaluated the LMA insertion skills of neonatal resuscitation providers. We wanted to study the proficiency of NRP providers in the technique of LMA insertion. We hypothesized that NRP providers would have LMA insertion skills equivalent to the standard of care (ETT insertion). Study Design A manikin-based study was done from July 2019 to December 2019. We enrolled 31 NRP providers with 1 or more years since the first certification and current valid NRP provider/instructor status. The participants were instructed to insert an ETT and LMA in the manikin. The procedures were video recorded. The time taken to insert and start ventilation with each device, including the number of attempts for successful insertion, was noted. A Likert scale questionnaire was filled by each participant indicating the level of confidence, perception of ease, and the ability to provide effective positive pressure ventilation (PPV) with each of the procedures. The paired t-test, chi-square test, and Kruskal–Wallis' test were used for the statistical analysis. Results Eight (25.8%) out of the 31 participants failed to insert any one of the devices. So, 23 providers were analyzed for the outcomes. We found that the mean duration taken to insert the ETT and LMA was not statistically different (32 vs. 36 seconds). LMA insertion had a higher failure rate compared with ETT. Providers did not perceive confidence to insert LMA when compared with ETT. They did not recognize LMA insertion as a more effortless procedure relative to endotracheal intubation. The providers felt that their ability to provide effective PPV using LMA was inferior to ETT. Conclusion The NRP certified providers in this study did not demonstrate proficiency in the insertion of LMA equivalent to the endotracheal intubation. Key Points

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Laryngeal Mask Ventilation during Tracheostomy Improves Intraoperative Hemodynamic Stability in Patients Undergoing Total Laryngectomy

Acta Medica Bulgarica ◽

10.2478/amb-2019-0022 ◽

2019 ◽

Vol 46 (3) ◽

pp. 5-9

Author(s):

Tz. Marinov ◽

T. M. Popov ◽

M. Belitova

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Local Anesthesia ◽

Laryngeal Cancer ◽

Total Laryngectomy ◽

Laryngeal Mask ◽

Mask Ventilation ◽

Hemodynamic Parameters ◽

Hemodynamic Stability

Abstract Background and objectives: Laryngectomy with extensive extirpational neck dissection is still the treatment of choice for patients with advanced laryngeal cancer. During the initial part of laryngectomy – tracheostomy, there is a significant upper airway obstruction, caused by the cancer process itself and worsened by surgical pressure and manipulation during creation of tracheostomy. This study aims to make comparative assessment of the patient’s hemodynamic parameters, operated using three of the most popular approaches during tracheostomy: local anesthesia with preserved spontaneous ventilation; general anesthesia with ventilation by endotracheal intubation and general anesthesia with ventilation by laryngeal mask airway. Methods: A prospective cohort study was conducted in a tertiary referral center. Sixty patients with advanced laryngeal cancer appointed for total laryngectomy, were enrolled in the study. They were randomly assigned into three groups, according to the ventilation method used during the tracheostomy. Results: Patients who underwent tracheostomy under local anesthesia displayed statistically the highest levels of SAP, DAP, MAP and heart rate intraoperatively. The group of patients who underwent tracheostomy with endotracheal intubation, also displayed significantly higher levels of hemodynamic parameters during the procedure compared with the group with laryngeal mask airway ventilation, despite the fact that both groups were under general anesthesia. Conclusions: To our knowledge, this is the first study to demonstrate that laryngeal mask ventilation during tracheostomy improves intraoperative hemodynamic stability in patients undergoing total laryngectomy compared to endotracheal intubation.

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