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Could laryngeal mask airways be used to stabilise neonates at birth by those with limited intubation experience?
  1. Julie Aitken,
  2. Joyce O'Shea
  1. Royal Hospital for Children, Glasgow, UK
  1. Correspondence to Dr Julie Aitken, Royal Hospital for Children, Glasgow G51 4TF, UK; julieaitken1{at}nhs.net

https://doi.org/10.1136/archdischild-2020-320284

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    Scenario

    A paediatric trainee is working nightshift in a district general neonatal unit. The consultant is not resident and is a thirty minute drive away. A term neonate is delivered in a poor condition unexpectedly. Initial resuscitation with face mask (FM) ventilation proves ineffective, so the trainee progresses to endotracheal (ET) intubation. The paediatric trainee has previously intubated three neonates under consultant supervision. ET intubation is successful on the fourth attempt, and the infant improves. The trainee finds the experience stressful and is anxious that she has prolonged the infant’s period of hypoxia. She also wonders whether a laryngeal mask airway (LMA) could have been used as an alternative to ET intubation in this scenario, as she has limited intubation experience.

    Structured clinical question

    When resuscitating a neonate at birth (patient), is positive pressure ventilation (PPV) with a LMA (intervention) more likely to be successful (outcome) than ventilation with a FM (comparison) or an endotracheal tube (ETT) (comparison) and how does the first insertion attempt success rate (outcome) of LMA (intervention) compare with ET intubation (comparison)?

    Search

    MEDLINE, Embase, Dynamed Plus, BMJ Best Practice, The Cochrane Library, Google Scholar and Clinicaltrials.gov were searched on 29th April 2020 using “neonate OR infant OR newborn AND laryngeal mask OR supraglottic airway OR supraglottic device OR i-Gel AND resuscitation OR resus OR life support”. The search was limited to English language. Only randomised controlled trials were eligible for review. The search generated 345 potential results, and 112 articles were fully evaluated. Eight studies met the inclusion criteria,1–8 involving a total of 874 infants. Five studies compared LMA with FM (661 infants) and four studies compared LMA with ETT (238 infants). One compared LMA with both ETT and FM6 (see table 1).

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    Table 1

    Summary of included studies

    Commentary

    Ventilation via a FM is …

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    Footnotes

    • Twitter @oshea_jem

    • Contributors JA contributed to the design of the systematic review, independently reviewed the journal titles, abstracts and full-text articles; drafted and revised the manuscript; and approved the final manuscript as submitted. JO contributed to the design of the systematic review, reviewed and revised the manuscript and approved the final manuscript as submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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