Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Review

Free Access

The Laryngeal Mask Airway and Its Use in Neonatal Resuscitation: A Critical Review of Where We Are in 2017/2018

Bansal S.C.a · Caoci S.c · Dempsey E.e, f · Trevisanuto D.d · Roehr C.C.a, b

Author affiliations

aNewborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Trust, Headley Way, and bDepartment of Paediatrics, University of Oxford, Oxford, UK; cDivision of Neonatology, Policlinico Umberto I, Sapienza University of Rome, Rome, and dDepartment of Women's and Children's Health, Padua University, Azienda Ospediliera di Padova, Padua,Italy; eDepartment of Paediatrics and Child Health and fIrish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland

Corresponding Author

Dr. Satvik Chaitanya Bansal

Newborn Services, John Radcliffe Hospital

Oxford University Hospitals, NHS Trust, Headley Way

Oxford, OX3 9DU (UK)

E-Mail drsatvikbansal@gmail.com

Related Articles for ""

Neonatology 2018;113:152-161

Abstract

Studies using videotape recordings and respiratory function monitoring have shown that both face mask (FM) application and endotracheal tube (ETT) placement represent a challenge for resuscitators. Hence, there is a strong need for devices that can largely be used independently of individual operator training levels, in order to ensure more reliable support in time-critical situations, such as neonatal resuscitation. The laryngeal mask airway device (LMA) has evolved as a potentially very valuable tool. We conducted a systematic review of studies evaluating the use of the LMA in neonatal resuscitation. An electronic literature search of large medical databases was performed to identify relevant publications on the use of an LMA during neonatal delivery room (DR) resuscitation. Following a rigorous systematic review, we identified a total of 7 randomized controlled trials with results indicating that initial respiratory management of newborn infants with an LMA is feasible for a defined subgroup of infants, but the evidence is still insufficient to recommend the LMA instead of FM ventilation in the DR. There is, in particular, a dearth of evidence of the use of LMA in neonates born before 34 weeks' gestational age or weighing <1,500 g at birth. There were no reports on significant complications following the use of LMA; however, evidence is still limited regarding short- and long-term outcomes. We conclude that the limited currently available evidence suggests that the use of the LMA is a feasible and safe alternative to mask ventilation of late preterm and term infants in the DR. The potential use of LMA resuscitation, in particular for low-gestation and low-birth-weight infants, needs further study.

© 2017 S. Karger AG, Basel


Introduction

At birth, newborns need to swiftly adapt from living in the fluid-filled intrauterine environment, where gas exchange is facilitated by the placenta, to the extrauterine, air-filled environment where gas exchange is accomplished through the lungs [1]. Despite this being a normal physiological process, up to 10% of newborns require some kind of respiratory support at birth to facilitate this process [2]. Consequently, proficient airway management is the most important aspect of successful neonatal stabilization and, ultimately, resuscitation [3]. Airway maneuvres most commonly entail the use of a face mask (FM) or nasopharyngeal interfaces (prongs) as the primary patient interfaces [4,5], either together with a self-inflating bag (SIB), a T-piece device, or, ultimately, intubation with an endotracheal tube (ETT) and possibly mechanical ventilation (MV). Recent studies, using videotape recordings and respiratory function monitoring during resuscitation, have shown that resuscitators are frequently significantly challenged with regard to appropriate FM application [6] and ETT placement [7]. Training neonatal resuscitation skills has been shown to improve specific and overall performance [8]; however, individual success rates for sufficient mask ventilation remain a challenge [9,10]. There is thus a need for devices that can largely be used independently of variable operator training levels to ensure more reliable support in time-critical situations, such as neonatal resuscitation [5]. Over the past years, proponents of the laryngeal mask airway device (LMA) have suggested that its use could circumvent the many caveats of insufficient FM ventilation and ETT placement [8,9].

The LMA, first developed between 1981 and 1987 by Brain [11], became available in 1988 for clinical use in adults and subsequently in pediatric patients. The classic LMA is a small elliptical mask with an inflatable cuff attached to an airway tube. It is inserted into the oral cavity using the operator's index finger, and is then guided along the hard palate, mimicking the swallowing of food. Once the device is fully inserted, the mask lumen sits over the laryngeal opening while the cuff conforms to the contours of the hypopharynx occluding the esophagus with a low-pressure seal. After inflating the cuff, the LMA can be used to control the airway of spontaneously breathing patients or to provide positive pressure ventilation (PPV) [12].

The use of the LMA in neonatal resuscitation was first demonstrated over 2 decades ago [13,14]. It has been suggested, time and again, that the ease of LMA insertion without the use of instruments and its reliability in ventilation make it an optimal alternative to the ETT [15]. The LMA was first introduced in the American Academy of Pediatrics (AAP) and American Heart Association (AHA) guidelines for neonatal resuscitation in 2000. Recently, in 2015, the ILCOR and ERC guidelines suggests its use as an alternative to ETT intubation in late preterm (>34 weeks' gestational age [GA]), full-term newborns, and/or newborns with a birth weight (BW) >2,000 g when FM ventilation is unsuccessful, and also recommend it when intubation is not feasible [2,3].

Over the years, a possible role of LMA has been described in various clinical settings such as meconium aspiration, the administration of emergency drugs and surfactant, and during chest compressions and neonatal transport. Consequently, it has been touted that its use could be especially crucial in settings where a lack of operator skill may prevent adequate ventilatory assistance [16]. Unfortunately, most of the evidence has been derived only from case reports and case series.

In this article, we will review the available literature on the use of the LMA in newborns, providing an overview for readers. We aim to explore the various indications of the LMA and point out any gaps in knowledge, in order to generate a direction for future studies.

Types of LMA

Several modifications have been made to the original design of the LMA in order to improve its effectiveness and ease of use, while limiting the potential complications. Currently, there are various LMAs available for use in newborns (Fig. 1):

Fig. 1

Various laryngeal mask airway (LMA) devices. a LMA Classic™. b LMA Supreme™. c LMA ProSeal™. d i-gel™. e Ambu® AuraOnce™. f Air-Q™. g Shiley™.

/WebMaterial/ShowPic/909506

1. LMA Classic™, LMA ProSeal™, and LMA Supreme™ (LMA North America Inc., San Diego, CA, USA),

2. i-gel™ supraglottic airway (Intersurgical, Liverpool, NY, USA),

3. Ambu® AuraOnce™ (Ambu A/S, Ballerup, Denmark),

4. Air-Q™ disposable laryngeal mask airway (Mercury Medical, Clearwater, FL, USA),

5. Shiley™ LMA (Medtronic, USA).

The LMA Classic is the original reusable design. LMA ProSeal has modified features to form a better seal with the periglottic tissues, allowing higher seal pressures to be safely achieved with similar ease of insertion compared to LMA Classic [17]. It also has a gastric vent for stomach air removal. LMA Supreme is a disposable polyvinyl chloride (PVC) LMA with an esophageal drain tube and a firm, curved, and anatomically shaped airway tube designed to achieve easier insertion without any introducer tool or placement by using fingers.

The Ambu AuraOnce is designed with a rigid curve in the main tube, which supposedly better replicates the human anatomical airway compared to the classic model. The Air -Q has a shorter and curved shaft, with a claimed advantage that it can be removed after tracheal intubation. The i-gel supraglottic airway is made from thermoplastic elastomer and has a noninflating soft-gel cuff, with the aim of reducing soft-tissue trauma. The Shiley LMA has greater tensile strength and lower flexibility, aiming to make insertion easier and decreasing the chance of occlusion.

All neonatal LMAs are available as “size 1” and are indicated for neonates with a BW of ≤5 kg, with the exception of the Air-Q disposable LMA, available as “size 0.5” but with an indication for infants with a BW <4.0 kg.

There have been studies conducted to compare the different types of LMAs, but these are mostly manikin-based studies. Micaglio et al. [17] compared the time from insertion to the first inflation of an artificial lung for the LMA Classic and the LMA ProSeal. The success rates of the first attempt were significantly higher with the LMA ProSeal (97 vs. 92% with the LMA Classic). They also compared delivered peak inflation pressures and suggested that the LMA Proseal provides a better laryngeal seal during PPV.

Trevisanuto et al. [18 ]compared LMA Supreme, LMA Classic, and LMA ProSeal in a manikin study, to assess the time to establish adequate ventilation and the ease of insertion. The success rate to insertion with the first attempt was comparable in all 3 devices. This study demonstrated that the LMA Supreme received higher ratings in terms of the ease of insertion as well as the effectiveness of ventilation compared with the other 2.

Although these are very useful in vitro studies, they cannot be considered equivalent to in vivo studies. Randomized control trials in neonates comparing the performance of various models are warranted.

Training in LMA Insertion

The use of neonatal manikins can be a valuable help to acquire the skills needed to successfully insert LMAs and assess their structural and functional characteristics [19].

In 2004, Gandini and Brimacombe [19 ]found that after a 15-min educational training program, the mean time to successful insertion of an LM was 5 s, and that the confidence in using the LMA, assessed by means of a pre- and posttraining questionnaire, increased from 8 to 97%. This suggests that proficiency in LMA positioning can be achieved after training on manikins alone, unlike endotracheal intubation. Studies aimed to train the medical professionals in the most efficient way are needed.

LMA in Neonatal Resuscitation

Search Strategy

An electronic search of the databases “MEDLINE” and “EMBASE” was performed to identify potentially relevant studies evaluating the use of a laryngeal mask during neonatal resuscitation. We used the following MeSH (headings) database search terms in PubMed: “Laryngeal Masks” [Majr] AND “Infant” [Majr] OR “Infant, Newborn” [Majr] AND “Resuscitation” [MeSH], and found 12 relevant results. We used no language limitations.

Searching EMBASE, we combined the following keywords: laryngeal mask airway, LMA, laryngeal mask, newborn, neonate, and resuscitation, and found 160 relevant results.

We also searched “clinicaltrials.gov” and “www.isrctn.com” for completed and ongoing trials. In all, we found 7 relevant randomized controlled trials (RCTs) comparing LMA to FM or ETT placement during resuscitation. The last update of our search strategy was performed on 25.09.2017. Ethics approval from a human research committee was not required.

Evidence from Observational Studies

During the 1990s, several observational studies were published which investigated, for the first time, the role of the LMA in neonatal resuscitation in the delivery room (DR) (Table 1). In 1994, Paterson et al. [20] reported the first prospective series using LMA instead of FM ventilation for 21 term and near-term newborns (BW 2,235-4,460 g). The study showed a success rate of LMA insertion during the first attempt in all 21 newborns, and 20 of the 21 were successfully resuscitated. One newborn did not respond to either LMA insertion or subsequent attempts at endotracheal intubation. Subsequently, Gandini and Brimacombe [21] reported a DR series of 104 neonates. Their series comprised 29 low-BW newborns and 6 very-low-BW newborns. All of the babies had the LMA successfully inserted at the first attempt, and effective ventilation was achieved in 103 out of 104. On average, adequate chest expansion was achieved within 10 s. In 2004, Trevisanuto et al. [22] retrospectively analyzed the records of neonates requiring PPV at birth, before (1996) and after (2000) the introduction of the LMA into clinical practice in their delivery suites, demonstrating a substantial reduction in the number of ETT insertions (67 vs. 34%). In addition, the outcome of the neonates treated with the LMA was compared with that of neonates matched for GA and mode of delivery that were resuscitated using an FM. In this case series, in 94 newborns out of 95 (99%), the LMA was easily inserted to provide a patent airway and effective ventilation. In 5 patients requiring prolonged PPV, the LMA was later replaced with an ETT to secure the airway before admission to the NICU.

Table 1

Overview of observation studies

/WebMaterial/ShowPic/909508

In a case-cohort study, Zanardo [23] aimed to determine whether unplanned resuscitation using an LMA is suitable for neonates delivered by elective cesarean section (CS). The authors included a subanalysis, in which resuscitations using the LMA were compared to those using an ETT following either a CS or a vaginal delivery. Overall, the newborns resuscitated with the LMA had better Apgar scores and required less respiratory support after delivery, suggesting, once again, that LMA may have some role in reducing the rate of intubation. However, in their study, the decision to use an LMA or ETT was left to the resuscitator's discretion without randomization. In 2010, in a 5-year observational study, the same authors reported that resuscitation of late preterm infants (34-37 weeks' GA) by using an LMA was associated with lower NICU admission rates and a shorter length of stay than mask-ventilation or endotracheal intubation [24]. However, the possibility of selection bias cannot be ruled out as the choice of PPV was at the clinician's discretion, and so may have resulted in sicker infants being resuscitated with either FM or ETT.

Evidence from RCTs

In 2012, Schmölzer et al. [25 ]conducted a systematic review on supraglottic airway devices during neonatal resuscitation, and concluded that resuscitation with an LMA was feasible and safe in infants of >34 weeks' GA and a BW >2,000 g, and that further RCTs were needed to demonstrate the short- and long-term clinical benefits of LMAs. In our review, 7 RCTs (Table 2) have been identified, involving a total of 744 infants, comparing LMA with either ETT or FM ventilation [26,27,28,29,30,31,32].

Table 2

Overview of RCTs comparing LMA to other modes

/WebMaterial/ShowPic/909507

In 4 RCTs, the comparison was between LMA and FM ventilation. Singh et al. [28] randomized (although there is not precise information regarding the randomization process) 50 neonates of >35 weeks' GA to either LMA or FM ventilation in the DR. The LMA group showed a higher rate success of ventilation (96 vs. 88%) and a shorter “pink-up time” (33.33 vs. 44.52 s). Both devices resulted in similar rates of endotracheal intubation and Apgar scores. Zhu et al. [27] randomized 369 newborn infants (>34 weeks' GA or weighing >2,000 g) to receive respiratory support at birth with either an LMA or an SIB plus an FM. LMAs were successfully inserted with the first attempt in 98.5%, with a mean insertion time of 7.8 s (±2.2). The LMA group had significantly higher successful resuscitation rates (99.02 vs. 84.15%), less ETT, and shorter MV times. However, this study was quasi-randomized using a date-based randomization where LMAs were being used only on even dates and SIBs on odd dates. No information is provided regarding the blinding process. In the last of these 3 trials, Trevisanuto et al. [30] compared LMA and FM ventilation in 142 infants (born at >34 weeks' GA and with a BW >1,500 g) assigned randomly to one of the devices. In this trial, for the first time, the LMA Supreme was used instead of the LMA Classic. The success rate of the resuscitation, which was the primary outcome, was significantly higher with the LMA Supreme than with a FM (91.5 vs. 78.9%; p = 0.03). Among the 37 patients with a BW between 1,500 and 2,000 g, the success rate was 86.7% (13/15) and 59.1% (13/22) in the LMA and FM groups, respectively (p = 0.14). Apgar score at 5 min was higher and the rate of NICU admission significantly lower in the LMA group than in the FM group (p = 0.02).

The trial conducted by Feroze et al. [29] compared LMA versus ETT or FM ventilation in 75 infants with a BW >1,500 g. The rate of successful resuscitation was higher with the LMA (95%) than with the ETT (90%) and FM (80%). No difference between the devices was reported for insertion time, but the time required to achieve an effective resuscitation in the bag-mask group was twice that in the LMA group.

Recently, Pejovic et al. [32] compared LMA with FM ventilation in babies >2,000 g and requiring PPV at birth in a resource-limited setting. They found that the time to spontaneous breathing (p = 0.005) and total ventilation time (p = 0.02) were shorter in the LMA arm than in the FM ventilation arm. The resuscitations were done by health staff after a short training program in neonatal resuscitation. This trial demonstrated that LMA can be used effectively by relatively inexperienced staff.

In 2 other RCTs, the comparison was between LMA and ETT. Esmail et al. [26] compared the size 1 LMA and endotracheal intubation during the neonatal resuscitation of infants at a single center (Cairo University, Egypt, 1999-2000). Forty newborns, born at or after 35 weeks' GA and delivered by CS, were assigned randomly to LMA (n = 20) or ETT (n = 20) by an anesthesiologist if their heart rate remained <100 beats/min after 1 min of bag-mask ventilation. There were no significant differences between the 2 groups regarding insertion time, failure rate at 1st attempt, resuscitation outcomes, or traumatic airway events. This trial was subject to bias in enrolment, allocation, and measurement of outcomes. The authors did not provide important details about the recruitment or randomization process. It is unclear how many potentially eligible subjects were excluded or if any subjects were excluded after randomization. With these limitations in mind, the study suggests that success with the LMA and ETT may be similar for establishing effective ventilation if attempts with an FM have been unsuccessful. In 2016, Yang et al. [31] compared the feasibility, efficacy, and safety of LMA and ETT in the neonatal resuscitation of 68 neonates born at >34 weeks' GA and with a BW >2,000 g, whose heart rate did not increase after 30 s of FM PPV. This was a quasi-randomized trial. There was no significant difference between groups in the rate of success for first-attempt insertion (although this was slightly higher with the LMA, i.e., 94.4 vs. 90.6% with the ETT), successful resuscitation, insertion time, response time, and ventilation time.

Overall, RCTs have shown that initial respiratory management with an LMA is feasible and safe. However, there is insufficient evidence to recommend LMA for initial respiratory support in the DR, and larger randomized trials are warranted before the technique can be widely applied. Currently, there is a dearth of evidence of the use of LMA in babies <34 weeks GA or a BW <1,500 g.

Other Uses of LMA

Surfactant Administration

Case reports by Brimacombe et al. [33], Trevisanuto et al. [34], and Micaglio et al. [35] demonstrate the feasibility of LMA for surfactant administration. A recent study reported a significant reduction of FiO2 (at baseline: 0.41 ± 0.04 and after 3 h: 0.23 ± 0.01) in 4 neonates after surfactant administration by using an Air-Q self-pressurizing LMA (size 0.5). The described technique involved using a particular LMA, having a conduit for intubation, and using this conduit to directly insert a thin catheter into the trachea for surfactant administration [36]. However, there have been concerns about whether a sufficient quantity of surfactant reaches the lungs.

Two RCTs reported surfactant administration via an LMA. The recent study by Pinheiro et al. [37] concluded that this therapy decreases the proportion of newborns with moderate respiratory distress syndrome that require MV, when compared with a standard endotracheal intubation procedure with sedation. Thirty patients with similar baseline characteristics were analyzed in each group. The failure rate was 77% in the ETT group and 30% in the LMA group (p < 0.001). However, interestingly, the difference was only related to early failure (i.e., the need for MV, or the use of naloxone to avoid MV within 1 h), suggesting that respiratory depression due to morphine premedication was principally responsible for the apparent superiority of the LMA strategy. The finding of a decreased oxygen requirement and the rates of adverse events were similar in the 2 groups. The other trial, by Attridge et al. [38], compared outcomes following surfactant administration by LMA or continuing with a standard therapy of nasal continuous positive airway pressure and supplemental oxygen, in infants with respiratory distress syndrome who have not yet reached the criteria for intubation, but this trial was abandoned due to low enrolment. As a consequence, currently, the evidence is not sufficient for promoting the routine use of LMA for surfactant administration and so this technique should be limited to clinical trials.

Epinephrine Administration

There is little evidence of the administration of epinephrine by an LMA. Most studies have been done on animal models and during adult resuscitation. Chen et al. [39] compared administration of epinephrine intravenously, by ETT, by injection in the upper end of the LMA, and via a catheter through the LMA, in a nonarrest adult porcine model. The authors observed no difference in peak plasma epinephrine levels, mean arterial blood pressure, and heart rate between the endotracheal route and injection via a catheter by the LMA route. Liao et al. [40] randomized 30 piglets to receive different epinephrine doses through either an ETT or an LMA via a catheter. The LMA group was divided to receive a 2-, 4-, or 6-fold dose of epinephrine compared to the dose administered by ETT. Interestingly, only the piglets in the ETT group and the 6-fold LMA group had elevated arterial pressure 1 min after administration, suggesting the need for a higher dose via LMA. We only found 1 case report on a newborn infant which demonstrated immediate improvement [41], so the currently available evidence is insufficient to form any recommendations on the administration of epinephrine by LMA.

Difficult Airway

Successful use of LMAs in babies with isolated upper airway or craniofacial malformations, in syndromes such as Pierre-Robin or Cornelia de Lange syndromes, or with airway malformations like laryngeal clefts have been described in some case reports [42,43,44,45,46]. The LMA provides an ideal alternative for the establishment of effective ventilation in such cases where endotracheal intubation is difficult or is ineffective.

The LMA has a role in neonatal transport. There are some published case reports of its use, especially in babies with difficult airways [47,48,49]. There are no RCTs comparing its effectiveness against high-flow/continuous positive airway pressure or endotracheal intubation during transport.

Long-Term MV

Authors do not recommend the use of LMAs for long-term MV due to a lack of evidence regarding their safety and efficacy, whereas ETTs have been almost universally used for long-term ventilation. There are the potential complications of lingual edema, and venous and capillary congestion with prolonged LMA use. Five neonatal case reports report using an LMA to provide MV for 2-6 days without apparent complications [43,45,50,51,52].

Complications of LMA

Complications are minor and few, and include soft-tissue trauma, vomiting, regurgitation, stridor, an improperly placed LMA leading to partial airway obstruction, and holding the breath. Esmail et al. [26] described minor soft-tissue trauma involving the epiglottis and uvula in 6 of 20 newborns resuscitated with an LMA, and 2 of these infants were treated with corticosteroids, but there were no long-term complications. Zhu et al. [27] reported a few cases of vomiting and regurgitation as the only complication associated with the insertion of LMA. The authors highlight that this was seen only in babies with higher Apgar scores (i.e., ≥7), probably related to the presence of airway reflexes so it was suggested that in such a situation, an FM and SIB may have been a safer option. Another study, published by the same group, reported vomiting and mild abdominal distention, which the authors attributed to an improper LMA seal over the glottis, with subsequent leaking into the esophagus [31]. Interestingly, there were no complications reported in the neonatal case series and retrospective cohorts of Paterson et al. [20], Gandini and Brimacombe [21], Trevisanuto et al. [22], and Zanardo et al. [24]. Although their final report did not mention any complications, Gandini and Brimacombe had previously reported a subset of the series in a letter to the Editor, noting that 2 patients appeared to have blood in their oropharynx when the laryngeal mask was removed [53]. In 2011, Trevisanuto [54 ]reported on an extremely low-BW infant with an upper esophageal lesion following LMA resuscitation, prompting questions regarding the need for smaller devices for the most premature babies and for studies to define the proper cuff inflation level.

Conclusion

The current evidence suggests that the use of LMA is a feasible and safe alternative to FM ventilation in late preterm and term infants. Further trials are needed to form recommendations on its use in neonatal resuscitation, in particular in infants with a BW <1,500 g. The potential use of LMA in smaller infants needs more studies. At present, evidence is still limited regarding short- and long-term outcomes. Additional trials are needed to demonstrate other uses of LMA such as drug and surfactant administration and long-term ventilation. Studies on the most appropriate training method for medical professionals also need to be undertaken.

Disclosure Statement

None of the authors has perceived conflicts of interest or financial relationships relevant to this review.


References

  1. Hooper SB, Polglase GR, Roehr CC: Cardiopulmonary changes with aeration of the newborn lung. Paediatr Respir Rev 2015;16:147-150.
  2. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al: Part 13. Neonatal resuscitation. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S543-S560.
  3. Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B: European Resuscitation Council Guidelines for Resuscitation 2015. Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015;95:249-263.
  4. Roehr CC, Schmalisch G, Khakban A, Proquitte H, Wauer RR: Use of continuous positive airway pressure (CPAP) in neonatal units - a survey of current preferences and practice in Germany. Eur J Med Res 2007;12:139-144.
    External Resources
  5. Roehr CC, Kelm M, Fischer HS, Bührer C, Schmalisch G, Proquitté H: Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision: Resuscitation 2010;81:202-205.
  6. Schmölzer GM, Morley CJ, Wong C, Dawson JA, Kamlin CO, Donath SM, Hooper SB, Davis PG: Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr 2012;160:377-381.
  7. Haubner LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D, Downes K, Auerbach M: Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation 2013;84:1359-1364.
  8. Mileder LP, Urlesberger B, Szyld EG, Roehr CC, Schmölzer GM: Simulation-based neonatal and infant resuscitation teaching: a systematic review of randomized controlled trials. Klin Padiatr 2014;226:259-267.
  9. Wood FE, Morley CJ, Dawson JA, Kamlin CO, Owen LS, Donath S, Davis PG: Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2. Arch Dis Child Fetal Neonatal Ed 2008;93:F230-F234.
  10. Schilleman K, Witlox RS, Lopriore E, Morley CJ, Walther FJ, te Pas AB: Leak and obstruction with mask ventilation during simulated neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 2010;95:F398-F402.
  11. Brain AI: The development of the laryngeal mask - a brief history of the invention, early clinical studies and experimental work from which the laryngeal mask evolved. Eur J Anaesthesiol Suppl 1991;4:5-17.
    External Resources
  12. Zanardo V, Simbi A, Micaglio M, Cavallin F, Tshilolo L, Trevisanuto D: Laryngeal mask airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC. BMC Health Serv Res 2010;10:254.
  13. Brimacombe J, Berry A: The laryngeal mask airway for obstetric anaesthesia and neonatal resuscitation. Int J Obstet Anesth 1994;3:211-218.
  14. Brimacombe J, Gandini D: The laryngeal mask airway: potential applications in neonatal health care. J Obstet Gynecol Neonatal Nurs 1997;26:171-178.
  15. Trevisanuto D, Micaglio M, Ferrarese P, Zanardo V: The laryngeal mask airway: potential applications in neonates: Arch Dis Child Fetal Neonatal Ed 2004;89:F485-F489.
  16. Grein AJ, Weiner GM: Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Cochrane Database Syst Rev 2005;18:CD003314.
  17. Micaglio M, Doglioni N, Parotto M, Zanardo V, Ori C, Trevisanuto D: Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA-ProSeal and the LMA-Classic in an airway management manikin. Pediatr Anaesth 2006;16:1028-1031.
  18. Trevisanuto D, Parotto M, Doglioni N, Ori C, Zanardo V, Micaglio M: The Supreme Laryngeal Mask Airway™ (LMA): a new neonatal supraglottic device: comparison with Classic and ProSeal LMA in a manikin. Resuscitation 2012;83:97-100.
  19. Gandini D, Brimacombe J: Manikin training for neonatal resuscitation with the laryngeal mask airway. Pediatr Anaesth 2004;14:493-494.
  20. Paterson SJ, Byrne PJ, Molesky MG, Seal RF, Finucane BT: Neonatal resuscitation using the laryngeal mask airway. Anesthesiology 1994;80:1248-1253.
    External Resources
  21. Gandini D, Brimacombe JR: Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anaesth Analg 1999;89:642-643.
  22. Trevisanuto D, Micaglio M, Pitton M, Magarotto M, Piva D, Zanardo V: Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004;62:151-157.
  23. Zanardo V: Neonatal resuscitation by laryngeal mask airway after elective caesarean section. Fetal Diagn Ther 2004;19:228-231.
  24. Zanardo V, Weiner G, Micaglio M, Doglioni N, Buzzacchero R, Trevisanuto D: Delivery room resuscitation of near-term infants: role of the laryngeal mask airway. Resuscitation 2010;81:327-330.
  25. Schmölzer GM, Agarwal M, Kamlin CO, Davis PG: Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation 2013;84:722-730.
  26. Esmail N, Saleh M, Ali A: Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Egypt J Anaesth 2002;18:115-121.
  27. Zhu XY, Lin BC, Zhang QS, Ye HM, Yu RJ: A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation 2011;82:1405-1409.
  28. Singh R, Mohan C, Taxak S: Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesthesiol Clin Pharmacol 2005;21:303.
  29. Feroze F, Khuwaja A, Masood N, Malik FI: Neonatal resuscitation: the use of laryngeal mask airway. Professional Med J 2008;15:148-152.
  30. Trevisanuto D, Cavallin F, Nguyen LN, Nguyen TV, Tran LD, Tran CD, Doglioni N, Micaglio M, Moccia L: Supreme laryngeal mask airway versus face mask during neonatal resuscitation: a randomized controlled trial. J Pediatr 2015;167:286-291.
  31. Yang C, Zhu X, Lin W, Zhang Q, Su J, Lin B, Ye H, Yu R: Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation - a secondary publication. BMC Pediatr 2016;16:17.
  32. Pejovic NJ, Trevisanuto D, Lubulwa C, Myrnerts Höök S, Cavallin F, Byamugisha J, Nankunda J, Tylleskär T: Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda. Arch Dis Child 2017;312934.
  33. Brimacombe J, Gandini D, Keller C: The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatr Anaesth 2004;14:188-190.
  34. Trevisanuto D, Doglioni N, Mario F, Micaglio M, Parotto M, Zanardo V: Drug administration via the laryngeal mask airway. Resuscitation 2006;71:263-264.
  35. Micaglio M, Zanardo V, Ori C, Parotto M, Doglioni N, Trevisanuto D: ProSeal LMA for surfactant administration. Paediatr Anaesth 2007;18:91-92.
  36. Vannozzi I, Ciantelli M, Moscuzza F, Scaramuzzo RT, Panizza D, Sigali E, Boldrini A, Cuttano A: Catheter and laryngeal mask endotracheal surfactant therapy: the CALMEST approach as a novel MIST technique. J Matern Fetal Neonatal Med 2017;30:2375-2377.
  37. Pinheiro JM, Santana-Rivas Q, Pezzano C: Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol 2016;36:196-201.
  38. Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J: Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial. Am J Perinatol 2013;30:201-206.
  39. Chen K-T, Lin H-J, Guo H-R, Lin M-T, Lin C-C: Feasibility study of epinephrine administration via laryngeal mask airway using a porcine model. Resuscitation 2006;69:503-507.
  40. Liao CK, Lin HJ, Foo NP, Lin CC, Guo HR, Chen KT: Epinephrine administration via a laryngeal mask airway: what is the optimal dose? Signa Vitae 2010;5:25-28.
  41. Brimacombe J, Gandini D: Airway rescue and drug delivery in an 800 g neonate with the laryngeal mask airway. Paediatr Anaesth 1999;9:178.
  42. Galderisi A, De Bernardo G, Lorenzon E, Trevisanuto D: i-gel: a new supraglottic device for effective resuscitation of a very low birthweight infant with Cornelia de Lange syndrome. BMJ Case Rep 2015, DOI: 10.1136/bcr-2014-209124.
  43. Gandini D, Brimacombe J: Laryngeal mask airway for ventilatory support over a 4-day period in a neonate with Pierre Robin sequence. Paediatr Anaesth 2003;13:181-182.
  44. Trawoger R, Mann C: Use of laryngeal masks in the resuscitation of a neonate with difficult airway. Arch Dis Child Fetal Neonatal Ed 1999;81:F159-F160.
  45. Yao CT, Wang JN, Tai YT, Tsai TY, Wu JM: Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long-term placement of a laryngeal mask airway. Resuscitation 2004;61:97-99.
  46. Leal-Pavey YR: Use of the LMA Classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report. AANA J 2004;72:427-430.
    External Resources
  47. Brimacombe J: Emergency use of a laryngeal mask airway during helicopter transfer of a neonate. J Clin Anaesth 1995;7:689-690.
  48. Fraser J, Hill C, McDonald D, Jones C, Petros A: The use of the laryngeal mask airway for inter-hospital transport of infants with type 3 laryngotracheo-oesophageal clefts. Intensive Care Med 1999;25:714-716.
  49. Trevisanuto D: Laryngeal mask airway for the interhospital transport of neonates. Pediatrics 2005;115:109-111.
    External Resources
  50. Bucx MJ, Grolman W, Kruisinga FH, Lindeboom JA, Van Kempen AA: The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome. Paediatr Anaesth 2003;13:530-533.
  51. Fernandez-Jurado MI, Fernandez-Baena M: Use of laryngeal mask airway for prolonged ventilatory support in a preterm newborn. Paediatr Anaesth 2002;12:369-370.
  52. Fraser J, Petros A: High-frequency oscillation via a laryngeal mask airway. Anaesthesia 1999;54:404.
  53. Brimacombe J: Neonatal resuscitation and the laryngeal mask. Anaesthesia 1995;50:1003.
  54. Trevisanuto D: Upper esophageal lesion following laryngeal mask airway resuscitation in a very low birth weight infant. Resuscitation 2011;82:1251-1252.

Author Contacts

Dr. Satvik Chaitanya Bansal

Newborn Services, John Radcliffe Hospital

Oxford University Hospitals, NHS Trust, Headley Way

Oxford, OX3 9DU (UK)

E-Mail drsatvikbansal@gmail.com


Article / Publication Details

First-Page Preview
Abstract of Review

Received: June 06, 2017
Accepted: October 05, 2017
Published online: December 13, 2017
Issue release date: Published online first

Number of Print Pages: 10
Number of Figures: 1
Number of Tables: 2

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Hooper SB, Polglase GR, Roehr CC: Cardiopulmonary changes with aeration of the newborn lung. Paediatr Respir Rev 2015;16:147-150.
  2. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al: Part 13. Neonatal resuscitation. 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S543-S560.
  3. Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B: European Resuscitation Council Guidelines for Resuscitation 2015. Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015;95:249-263.
  4. Roehr CC, Schmalisch G, Khakban A, Proquitte H, Wauer RR: Use of continuous positive airway pressure (CPAP) in neonatal units - a survey of current preferences and practice in Germany. Eur J Med Res 2007;12:139-144.
    External Resources
  5. Roehr CC, Kelm M, Fischer HS, Bührer C, Schmalisch G, Proquitté H: Manual ventilation devices in neonatal resuscitation: tidal volume and positive pressure-provision: Resuscitation 2010;81:202-205.
  6. Schmölzer GM, Morley CJ, Wong C, Dawson JA, Kamlin CO, Donath SM, Hooper SB, Davis PG: Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study. J Pediatr 2012;160:377-381.
  7. Haubner LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D, Downes K, Auerbach M: Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation 2013;84:1359-1364.
  8. Mileder LP, Urlesberger B, Szyld EG, Roehr CC, Schmölzer GM: Simulation-based neonatal and infant resuscitation teaching: a systematic review of randomized controlled trials. Klin Padiatr 2014;226:259-267.
  9. Wood FE, Morley CJ, Dawson JA, Kamlin CO, Owen LS, Donath S, Davis PG: Improved techniques reduce face mask leak during simulated neonatal resuscitation: study 2. Arch Dis Child Fetal Neonatal Ed 2008;93:F230-F234.
  10. Schilleman K, Witlox RS, Lopriore E, Morley CJ, Walther FJ, te Pas AB: Leak and obstruction with mask ventilation during simulated neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed 2010;95:F398-F402.
  11. Brain AI: The development of the laryngeal mask - a brief history of the invention, early clinical studies and experimental work from which the laryngeal mask evolved. Eur J Anaesthesiol Suppl 1991;4:5-17.
    External Resources
  12. Zanardo V, Simbi A, Micaglio M, Cavallin F, Tshilolo L, Trevisanuto D: Laryngeal mask airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC. BMC Health Serv Res 2010;10:254.
  13. Brimacombe J, Berry A: The laryngeal mask airway for obstetric anaesthesia and neonatal resuscitation. Int J Obstet Anesth 1994;3:211-218.
  14. Brimacombe J, Gandini D: The laryngeal mask airway: potential applications in neonatal health care. J Obstet Gynecol Neonatal Nurs 1997;26:171-178.
  15. Trevisanuto D, Micaglio M, Ferrarese P, Zanardo V: The laryngeal mask airway: potential applications in neonates: Arch Dis Child Fetal Neonatal Ed 2004;89:F485-F489.
  16. Grein AJ, Weiner GM: Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Cochrane Database Syst Rev 2005;18:CD003314.
  17. Micaglio M, Doglioni N, Parotto M, Zanardo V, Ori C, Trevisanuto D: Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA-ProSeal and the LMA-Classic in an airway management manikin. Pediatr Anaesth 2006;16:1028-1031.
  18. Trevisanuto D, Parotto M, Doglioni N, Ori C, Zanardo V, Micaglio M: The Supreme Laryngeal Mask Airway™ (LMA): a new neonatal supraglottic device: comparison with Classic and ProSeal LMA in a manikin. Resuscitation 2012;83:97-100.
  19. Gandini D, Brimacombe J: Manikin training for neonatal resuscitation with the laryngeal mask airway. Pediatr Anaesth 2004;14:493-494.
  20. Paterson SJ, Byrne PJ, Molesky MG, Seal RF, Finucane BT: Neonatal resuscitation using the laryngeal mask airway. Anesthesiology 1994;80:1248-1253.
    External Resources
  21. Gandini D, Brimacombe JR: Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anaesth Analg 1999;89:642-643.
  22. Trevisanuto D, Micaglio M, Pitton M, Magarotto M, Piva D, Zanardo V: Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004;62:151-157.
  23. Zanardo V: Neonatal resuscitation by laryngeal mask airway after elective caesarean section. Fetal Diagn Ther 2004;19:228-231.
  24. Zanardo V, Weiner G, Micaglio M, Doglioni N, Buzzacchero R, Trevisanuto D: Delivery room resuscitation of near-term infants: role of the laryngeal mask airway. Resuscitation 2010;81:327-330.
  25. Schmölzer GM, Agarwal M, Kamlin CO, Davis PG: Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation 2013;84:722-730.
  26. Esmail N, Saleh M, Ali A: Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Egypt J Anaesth 2002;18:115-121.
  27. Zhu XY, Lin BC, Zhang QS, Ye HM, Yu RJ: A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation 2011;82:1405-1409.
  28. Singh R, Mohan C, Taxak S: Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesthesiol Clin Pharmacol 2005;21:303.
  29. Feroze F, Khuwaja A, Masood N, Malik FI: Neonatal resuscitation: the use of laryngeal mask airway. Professional Med J 2008;15:148-152.
  30. Trevisanuto D, Cavallin F, Nguyen LN, Nguyen TV, Tran LD, Tran CD, Doglioni N, Micaglio M, Moccia L: Supreme laryngeal mask airway versus face mask during neonatal resuscitation: a randomized controlled trial. J Pediatr 2015;167:286-291.
  31. Yang C, Zhu X, Lin W, Zhang Q, Su J, Lin B, Ye H, Yu R: Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation - a secondary publication. BMC Pediatr 2016;16:17.
  32. Pejovic NJ, Trevisanuto D, Lubulwa C, Myrnerts Höök S, Cavallin F, Byamugisha J, Nankunda J, Tylleskär T: Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda. Arch Dis Child 2017;312934.
  33. Brimacombe J, Gandini D, Keller C: The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatr Anaesth 2004;14:188-190.
  34. Trevisanuto D, Doglioni N, Mario F, Micaglio M, Parotto M, Zanardo V: Drug administration via the laryngeal mask airway. Resuscitation 2006;71:263-264.
  35. Micaglio M, Zanardo V, Ori C, Parotto M, Doglioni N, Trevisanuto D: ProSeal LMA for surfactant administration. Paediatr Anaesth 2007;18:91-92.
  36. Vannozzi I, Ciantelli M, Moscuzza F, Scaramuzzo RT, Panizza D, Sigali E, Boldrini A, Cuttano A: Catheter and laryngeal mask endotracheal surfactant therapy: the CALMEST approach as a novel MIST technique. J Matern Fetal Neonatal Med 2017;30:2375-2377.
  37. Pinheiro JM, Santana-Rivas Q, Pezzano C: Randomized trial of laryngeal mask airway versus endotracheal intubation for surfactant delivery. J Perinatol 2016;36:196-201.
  38. Attridge JT, Stewart C, Stukenborg GJ, Kattwinkel J: Administration of rescue surfactant by laryngeal mask airway: lessons from a pilot trial. Am J Perinatol 2013;30:201-206.
  39. Chen K-T, Lin H-J, Guo H-R, Lin M-T, Lin C-C: Feasibility study of epinephrine administration via laryngeal mask airway using a porcine model. Resuscitation 2006;69:503-507.
  40. Liao CK, Lin HJ, Foo NP, Lin CC, Guo HR, Chen KT: Epinephrine administration via a laryngeal mask airway: what is the optimal dose? Signa Vitae 2010;5:25-28.
  41. Brimacombe J, Gandini D: Airway rescue and drug delivery in an 800 g neonate with the laryngeal mask airway. Paediatr Anaesth 1999;9:178.
  42. Galderisi A, De Bernardo G, Lorenzon E, Trevisanuto D: i-gel: a new supraglottic device for effective resuscitation of a very low birthweight infant with Cornelia de Lange syndrome. BMJ Case Rep 2015, DOI: 10.1136/bcr-2014-209124.
  43. Gandini D, Brimacombe J: Laryngeal mask airway for ventilatory support over a 4-day period in a neonate with Pierre Robin sequence. Paediatr Anaesth 2003;13:181-182.
  44. Trawoger R, Mann C: Use of laryngeal masks in the resuscitation of a neonate with difficult airway. Arch Dis Child Fetal Neonatal Ed 1999;81:F159-F160.
  45. Yao CT, Wang JN, Tai YT, Tsai TY, Wu JM: Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long-term placement of a laryngeal mask airway. Resuscitation 2004;61:97-99.
  46. Leal-Pavey YR: Use of the LMA Classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report. AANA J 2004;72:427-430.
    External Resources
  47. Brimacombe J: Emergency use of a laryngeal mask airway during helicopter transfer of a neonate. J Clin Anaesth 1995;7:689-690.
  48. Fraser J, Hill C, McDonald D, Jones C, Petros A: The use of the laryngeal mask airway for inter-hospital transport of infants with type 3 laryngotracheo-oesophageal clefts. Intensive Care Med 1999;25:714-716.
  49. Trevisanuto D: Laryngeal mask airway for the interhospital transport of neonates. Pediatrics 2005;115:109-111.
    External Resources
  50. Bucx MJ, Grolman W, Kruisinga FH, Lindeboom JA, Van Kempen AA: The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome. Paediatr Anaesth 2003;13:530-533.
  51. Fernandez-Jurado MI, Fernandez-Baena M: Use of laryngeal mask airway for prolonged ventilatory support in a preterm newborn. Paediatr Anaesth 2002;12:369-370.
  52. Fraser J, Petros A: High-frequency oscillation via a laryngeal mask airway. Anaesthesia 1999;54:404.
  53. Brimacombe J: Neonatal resuscitation and the laryngeal mask. Anaesthesia 1995;50:1003.
  54. Trevisanuto D: Upper esophageal lesion following laryngeal mask airway resuscitation in a very low birth weight infant. Resuscitation 2011;82:1251-1252.
ppt logo Download Images (.pptx)


Figures
Thumbnail

Tables
Thumbnail
Thumbnail