Updates in neonatal resuscitation: routine use of laryngeal masks as an alternative to face masks

다국어 초록 (Multilingual Abstract)

Although positive-pressure ventilation (PPV) has traditionally been performed using a face mask in neonatal resuscitation, face mask ventilation for delivering PPV has a high failure rate due to mask leaks, airway obstruction, or gastric inflation.
Furthermore, face mask ventilation is compromised during chest compressions. Endotrachealintubation in neonates requires a high skill level, with a first-attempt success rate of <50%. Laryngeal masks can transfer positive pressure more effectively even during chest compressions, resulting in a lower PPV failure rate compared to that of face masks in neonatal resuscitation.
In addition, inserting a laryngeal mask is easier and more accessible than endotracheal intubation, and mortality rates do not differ between the 2 methods.
Therefore, in neonatal resuscitation, laryngeal masks are recommended in infants with gestational age >34 weeks and/or with a birth weight >2 kg, in cases of unsuccessful face mask ventilation (as a primary airway device) or endotracheal intubation (as a secondary airway device, alternative airway).
In other words, laryngeal masks are recommended when endotracheal intubation fails as well as when PPV cannot be achieved. Although laryngeal masks are commonly used in anesthetized pediatric patients, they are infrequently used in neonatal resuscitation due to limited experience, a preference for endotracheal tubes, or a lack of awareness among the healthcare providers.
Thus, healthcare providers must be aware of the usefulness of laryngeal masks in depressed neonates requiring PPV or endotracheal intubation, which can promptly resuscitate these infants and improve their outcomes, resulting in decreased morbidity and mortality rates.

참고문헌 (Reference)

1 Lyra JC, "Use of laryngeal mask for neonatal resuscitation in Brazil : a national survey" 13 : 100336-, 2022

2 Trevisanuto D, "Upper esophageal lesion following laryngeal mask airway resuscitation in a very low birth weight infant" 82 : 1251-1252, 2011

3 Brimacombe J, "The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome" 14 : 188-190, 2004

4 Trevisanuto D, "The Supreme Laryngeal Mask AirwayTM(LMA) : a new neonatal supraglottic device : comparison with Classic and ProSeal LMA in a manikin" 83 : 97-100, 2012

5 American Academy of Pediatrics, "Textbook of neonatal resuscitation" American Academy of Pediatrics 65-114, 2016

6 American Academy of Pediatrics, "Textbook of neonatal resuscitation" American Academy of Pediatrics 65-116, 2021

7 American Academy of Pediatrics, "Textbook of neonatal resuscitation" American Academy of Pediatrics 115-161, 2016

8 Trevisanuto D, "Supreme laryngeal mask airway versus face mask during neonatal resuscitation : a randomized controlled trial" 167 : 286-291, 2015

9 Yamada NK, "Supraglottic airways compared with face masks for neonatal resuscitation : a systematic review" 150 : e2022056568-, 2022

10 Boldingh AM, "Suboptimal heart rate assessment and airway management in infants receiving delivery room chest compressions : a quality assurance project" 105 : 545-549, 2020

11 Roehr CC, "Reply letter to : Intubation in neonatal resuscitation-compelling necessity or incalculable risk?" 165 : 190-191, 2021

12 Yang C, "Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation---a secondary publication" 16 : 17-, 2016

13 Mani S, "Proficiency of laryngeal mask airway insertion skill in NRP certified providers" 39 : 1008-1014, 2022

14 Barbosa RF, "ProSealTM laryngeal mask airway for surfactant administration in the treatment of respiratory distress syndrome in a premature infant" 24 : 207-210, 2012

15 Micaglio M, "ProSeal LMA for surfactant administration" 18 : 91-92, 2008

16 Isobe A, "One-rescuer newborn CPR using a face mask or an i-gel supraglottic airway and two-finger compressions-a manikin study with cross-over design" 11 : 100276-, 2022

17 Paterson SJ, "Neonatal resuscitation using the laryngeal mask airway" 80 : 1248-1253, 1994

18 Pejovic NJ, "Neonatal resuscitation using a laryngeal mask airway : a randomised trial in Uganda" 103 : 255-260, 2018

19 Feroze F, "Neonatal resuscitation : the use of laryngeal mask airway" 15 : 148-152, 2008

20 Foglia EE, "Neonatal intubation practice and outcomes : an international registry study" 143 : e20180902-, 2019

21 Tracy MB, "Mask leak increases and minute ventilation decreases when chest compressions are added to bag ventilation in a neonatal manikin model" 103 : e182-e187, 2014

22 Mani S, "Laryngeal mask ventilation with chest compression during neonatal resuscitation : randomized, non-inferiority trial in lambs" 92 : 671-677, 2022

23 White L, "Laryngeal mask ventilation during neonatal resuscitation : a case series" 9 : 897-, 2022

24 Shah BA, "Laryngeal mask use in the neonatal population : a survey of practice providers at a regional tertiary care center in the United States" 40 : 1551-1557, 2023

25 Diggikar S, "Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in lowand-middle-income countries : a systematic review and metaanalysis" 108 : 156-163, 2023

26 Qureshi MJ, "Laryngeal mask airway versus bagmask ventilation or endotracheal intubation for neonatal resuscitation" 3 : CD003314-, 2018

27 Trevisanuto D, "Laryngeal mask airway used as a delivery conduit for the administration of surfactant to preterm infants with respiratory distress syndrome" 87 : 217-220, 2005

28 Abdel-Latif ME, "Laryngeal mask airway surfactant administration for prevention of morbidity and mortality in preterm infants with or at risk of respiratory distress syndrome" (7) : CD008309-, 2011

29 Mathai SS, "Laryngeal mask airway as primary mode in neonatal resuscitation – does it reduce need of positive pressure ventilation?" 2014 : 216089-, 2014

30 Vali P, "Laryngeal mask airway : an alternate option for all phases of neonatal resuscitation" 92 : 626-628, 2022

31 Schwindt J, "Intubation in neonatal resuscitation-compelling necessity or incalculable risk?" 165 : 188-189, 2021

32 Belkhatir K, "Experience and training in endotracheal intubation and laryngeal mask airway use in neonates : results of a national survey" 106 : 223-224, 2021

33 El-Shimi MS, "Efficacy of laryngeal mask airway in neonatal resuscitation" 70 : 1767-1772, 2018

34 Singh R, "Controlled trial to evaluate the use of LMA for neonatal resuscitation" 21 : 303-306, 2005

35 Liu J, "Comparison of the airway complications of subtypes of laryngeal mask airway and i-gel in child patients under general anaesthesia : a protocol for systematic review and network meta-analysis of randomised control trials" 10 : e032691-, 2020

36 Ankay-Yılbaş A, "Comparison of i-gel, LMA-supreme, LMA-classic and LMAproseal as conduits of endotracheal intubation in newborns and infants : a manikin study" 61 : 166-173, 2019

37 Ozden ES, "Comparison of ProSeal laryngeal mask airway(PLMA)with cuffed and uncuffed endotracheal tubes in infants" 16 : 286-291, 2016

38 Huynh T, "Assessment of effective face mask ventilation is compromised during synchronised chest compressions" 100 : F39-F42, 2015

39 Attridge JT, "Administration of rescue surfactant by laryngeal mask airway : lessons from a pilot trial" 30 : 201-206, 2013

40 Pejovic NJ, "A randomized trial of laryngeal mask airway in neonatal resuscitation" 383 : 2138-2147, 2020

41 Wyckoff MH, "2020 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care Science with treatment recommendations" 147 (147): e2020038505-, 2021