Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC

Abstract

BackgroundStudies carried out in developing countries have indicated that training courses in newborn resuscitation are efficacious in teaching local birth attendants how to properly utilize simple resuscitation devices. The aim of this study was to assess the knowledge and expertise gained by physicians and midwifes who participated in a Neonatal Resuscitation Course and workshop organized in a Third World Country on the use of Laryngeal Mask Airway (LMA).MethodsA 28-item questionnaire, derived from the standard test contained in the American Heart Association and the American Academy of Pediatrics Neonatal Resuscitation Manual, was administered to 21 physicians and 7 midwifes before and after a course, which included a practical, hands-on workshop focusing on LMA positioning and bag-ventilation in a neonatal manikin.ResultsThe knowledge gained by the physicians was superior to that demonstrated by the midwifes. The physicians, in fact, demonstrated a significant improvement with respect to their pre-course knowledge. Both the physicians and the midwives showed a good level of expertise in manipulating the manipulating the manikin during the practical trial session. The midwifes and physicians almost unanimously manifested a high degree of approval of neonatal resuscitation by LMA, as they defined it a sustainable and cost-effective method requiring minimal expertise.ConclusionsFurther studies are warranted to test the advantages and limits of the neonatal LMA training courses in developing countries.

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

“…All participants (7 midwives and 21 physicians), expressed a high degree of approval with regard to neonatal resuscitation by LMA and defined it a sustainable and cost-effective procedure. 26 The present study, conducted in a middle resource setting after a short training of the staff, confirms these features. As the effectiveness and safety of the SLMA as well as the grade of satisfaction expressed by the staff were high, we believe that using LMA use for neonatal resuscitation might be easier than tracheal intubation, especially in settings where staffs are not familiar with tracheal intubation.…”

“…Furthermore, it is important that our results are in agreement with a recent RCT showing that basic life support trained nurses were able to ventilate more efficiently with SLMA than with face mask or laryngeal tube suctiondisposable after 1 hour of introductory training. 26 The findings of our study are important for other units/settings in high as well low resource countries where neonatal resuscitation is more often performed by pediatricians, midwives, or nurses. In agreement with the study by Zhu et al, our results confirm that a short-term educational program on the LMA use is effective in the clinical practice.…”

Newborn Resuscitation Training in Resource-Limited Settings: A Systematic Literature Review

“…Ten (22.2%) of the 45 studies reported a breakdown of scores according to cadre, 26,36,39,40,44,50,53,55,56,74 and 7 (70.0%) of these studies showed that birth attendants from lower cadres (eg, midwives) improved significantly more from pretraining to posttraining than those from higher cadres (eg, physicians). 26,40,42,50,53,56,74 In all 7 of these studies, significant differences in pretraining test performance between different cadres were diminished or completely eliminated upon retesting after training. Similarly, a study from HBB in Tanzania found that nurses outperformed health care providers of both higher and lower training levels on a standardized OSCE.…”

Laryngeal Mask Airway as Primary Mode in Neonatal Resuscitation –Does it Reduce Need of Positive Pressure Ventilation?

“…Over this period, the percentage of neonates receiving tracheal intubation at birth (34%) was significantly reduced compared with earlier figures (67%). In a recent study on training in use of LMA in a resource-limited country Zanardo (2010), it has been shown that both physicians and paramedics showed a significant improvement in their knowledge post training.…”