scholarly journals Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda

2017 ◽  
Vol 103 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Nicolas J Pejovic ◽  
Daniele Trevisanuto ◽  
Clare Lubulwa ◽  
Susanna Myrnerts Höök ◽  
Francesco Cavallin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laryngeal Mask Airway ◽  
Low Income ◽  
Spontaneous Breathing ◽  
Randomised Trial ◽  
Neonatal Resuscitation ◽  
Face Mask ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Link Type

ObjectiveMortality rates from birth asphyxia in low-income countries remain high. Face mask ventilation (FMV) performed by midwives is the usual method of resuscitating neonates in such settings but may not always be effective. The i-gel is a cuffless laryngeal mask airway (LMA) that could enhance neonatal resuscitation performance. We aimed to compare LMA and face mask (FM) during neonatal resuscitation in a low-resource setting.SettingMulago National Referral Hospital, Kampala, Uganda.DesignThis prospective randomised clinical trial was conducted at the labour ward operating theatre. After a brief training on LMA and FM use, infants with a birth weight >2000 g and requiring positive pressure ventilation at birth were randomised to resuscitation by LMA or FM. Resuscitations were video recorded.Main outcome measuresTime to spontaneous breathing.ResultsForty-nine (24 in the LMA and 25 in the FM arm) out of 50 enrolled patients were analysed. Baseline characteristics were comparable between the two arms. Time to spontaneous breathing was shorter in LMA arm than in FM arm (mean 153 s (SD±59) vs 216 s (SD±92)). All resuscitations were effective in LMA arm, whereas 11 patients receiving FM were converted to LMA because response to FMV was unsatisfactory. There were no adverse effects.ConclusionA cuffless LMA was more effective than FM in reducing time to spontaneous breathing. LMA seems to be safe and effective in clinical practice after a short training programme. Its potential benefits on long-term outcomes need to be assessed in a larger trial.Clinical trial registryThis trial was registered in https://clinicaltrials.gov, with registration number NCT02042118.

Supreme Laryngeal Mask Airway versus Face Mask during Neonatal Resuscitation: A Randomized Controlled Trial

2015 ◽  
Vol 167 (2) ◽  
pp. 286-291.e1 ◽  
Author(s):  
Daniele Trevisanuto ◽  
Francesco Cavallin ◽  
Loi Ngoc Nguyen ◽  
Tien Viet Nguyen ◽  
Linh Dieu Tran ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Laryngeal Mask Airway ◽  
Controlled Trial ◽  
Neonatal Resuscitation ◽  
Face Mask ◽  
Laryngeal Mask ◽  
Randomized Controlled

scholarly journals Proficiency of Laryngeal Mask Airway Insertion Skill in NRP Certified Providers

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

Resuscitation of Neonates with the Laryngeal Mask Airway—A Caution

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 453-454
Author(s):  
Joe Brimacombe ◽  
D. Gandini
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Pressure ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Neonatal Resuscitation ◽  
Standard Technique ◽  
Intermittent Positive Pressure Ventilation ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Meconium Aspiration

We would like to report our experience with the laryngeal mask airway (LMA) for neonatal resuscitation. The LMA was used in neonates with apnea or heart rate &lt;100 min-1 who had no evidence of meconium aspiration. The LMA was inserted using the standard technique with the cuff fully deflated and then inflated with 2 to 5 mL air.1 It was then held in place manually and connected to a pediatric Mapleson F circuit. Intermittent positive-pressure ventilation or continuous positive airway pressure was administered until respiration was established.

How do different brands of size 1 laryngeal mask airway compare with face mask ventilation in a dedicated laryngeal mask airway teaching manikin?

2017 ◽  
Vol 103 (3) ◽  
pp. F271-F276 ◽  
Author(s):  
Mark Brian Tracy ◽  
Archana Priyadarshi ◽  
Dimple Goel ◽  
Krista Lowe ◽  
Jacqueline Huvanandana ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Peak Inspiratory Pressure ◽  
Face Mask ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Mask Ventilation ◽  
Resuscitation Guidelines ◽  
Bag Mask Ventilation

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.

scholarly journals A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Erol Karaaslan ◽  
Sedat Akbas ◽  
Ahmet Selim Ozkan ◽  
Cemil Colak ◽  
Zekine Begec
Keyword(s):  
Laryngeal Mask Airway ◽  
Adverse Events ◽  
Endotracheal Tube ◽  
Sore Throat ◽  
Fiberoptic Bronchoscopy ◽  
Laryngeal Mask ◽  
Controlled Clinical Trial ◽  
Airway Protection ◽  
Link Type ◽  
Single Blind

Abstract Background There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events. Methods The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia. Results In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups. Conclusion The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases. Trial registration This trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03903679 on April 5, 2019.

The Laryngeal Mask Airway and Positive-pressure Ventilation

1994 ◽  
Vol 80 (3) ◽  
pp. 550-555 ◽  
Author(s):  
J. Hugh Devitt ◽  
Richard Wenstone ◽  
Alva G. Noel ◽  
Michael P. O'Donnell
Keyword(s):  
Laryngeal Mask Airway ◽  
Positive Pressure Ventilation ◽  
Laryngeal Mask ◽  
Positive Pressure

Safe emergency neonatal airway management: current challenges and potential approaches

2021 ◽  
pp. fetalneonatal-2020-319398
Author(s):  
Joyce E O'Shea ◽  
Alexandra Scrivens ◽  
Gemma Edwards ◽  
Charles Christoph Roehr
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Neonatal Resuscitation ◽  
Laryngeal Mask ◽  
Viable Alternative ◽  
Supraglottic Airway ◽  
Success Rates ◽  
Facemask Ventilation

This review examines the airway adjuncts currently used to acutely manage the neonatal airway. It describes the challenges encountered with facemask ventilation and intubation. Evidence is presented on how to optimise intubation safety and success rates with the use of videolaryngoscopy and attention to the intubation environment. The supraglottic airway (laryngeal mask airway) is emerging as a promising neonatal airway adjunct. It can be used effectively with little training to provide a viable alternative to facemask ventilation and intubation in neonatal resuscitation and be used as an alternative conduit for the administration of surfactant.

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