Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation---a secondary publication

Abstract

BackgroundThis study aimed to study the feasibility, efficacy and safety of using laryngeal mask (LM) ventilation compared with endotracheal intubation (ETI) during neonatal resuscitation.MethodsNeonates with a heart rate below 60 beats per minute despite 30 s of face mask ventilation were assigned quasi-randomly (odd/even birth date) to LM (n = 36) or ETI (n = 32) ventilation. Differences in first attempt insertion success, insertion time, Apgar score, resuscitation outcome, and adverse effects were compared.ResultsThere were no significant differences in first attempt at successful insertion (LM, 94.4 % vs. ETI, 90.6 %), insertion time (LM, 7.58 ± 1.16 s vs. ETI, 7.89 ± 1.52 s), Apgar score at 1 and 5 min, response time, ventilation time, successful resuscitation (LM, 86.1 % vs. ETI, 96.9 %), and adverse events (LM, n =3 vs. ETI, n =4) between groups.ConclusionsLaryngeal mask ventilation is an effective alternative to endotracheal intubation during resuscitation of depressed newborns who do not respond to face-mask ventilation. During an emergency, laryngeal mask ventilation may be a preferred technique for medical staff who are unable to acquire or maintain endotracheal intubation skills. Trial registration: Current Controlled Trials ChiCTR-IOQ-15006488. Registered on 2 June 2015.

Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

“…We included a total of seven randomised controlled trials that met the inclusion criteria ( Figure 1). Five studies (661 infants) compared laryngeal mask airway (LMA) to bag and face mask manual ventilation (BMV) (Feroze 2008;Pejovic 2015;Singh 2005;; Zhu 2011); and three studies (158 infants) compared LMA with endotracheal intubation (Esmail 2002;Feroze 2008;Yang 2016).…”

“…Three studies, which enrolled a total of 158 infants, compared LMA with endotracheal intubation (Esmail 2002;Feroze 2008;Yang 2016).…”

“…Data from two studies (Esmail 2002;Yang 2016) reporting this outcome were pooled for meta-analysis, with no di erence noted across the intervention groups (RR 1.01, 95% CI 0.89 to 1.14). Feroze 2008 did not provide data in a format that could be included for meta-analysis, however, it was mentioned that one to two attempts were required for insertion of LMA compared to two to three attempts for endotracheal intubation.…”

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

“…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].…”

“…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.…”