The Laryngeal Mask

Abstract

Background: Since 2005, the Neonatal Resuscitation Program (NRP) has recommended the laryngeal mask (LM) as an alternative airway when positive-pressure ventilation (PPV) is unsuccessful and intubation is unsuccessful or unfeasible. There is a paucity of literature regarding LM use in high-resource countries; however, anecdotal information and recent studies suggest low implementation. Purpose: This article increases awareness of LM safety and efficacy, provides guidance for determining nursing scope of practice, and includes suggestions for developing a training program. Methods: Methods include considering NRP customers' questions, recent systematic reviews of the literature, how NRP recommendations are developed, how to determine nursing scope of practice, and how to develop a training program. Findings/Results: Recent studies support the NRP recommendation to use the LM as a rescue airway when PPV fails and intubation is not feasible. The LM provides more effective PPV than face-mask ventilation. The LM may be effective as the initial PPV device for infants of at least 34 weeks' gestation. To use the LM, nurses may require training, which may include a simulation-based curriculum. Implications for Practice: Nurses can increase their awareness of the advantages of LM use, determine their scope of practice, and develop a training program. When face-mask ventilation is unsuccessful and intubation is unfeasible, LM insertion will likely increase the newborn's heart rate and avoid intubation. Implications for Research: Future research should determine training requirements, efficacy of the LM as the initial PPV device in high-resource settings, and LM use during complex resuscitation and in preterm newborns.

Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors

“… 5 In contrast, LM insertion can be learned by inexperienced airway providers in a single training session. 16 , 17 Prioritizing LM over intubation during neonatal resuscitation may improve patient safety by establishing effective ventilation quickly, enabling initial resuscitation providers to establish an alternative airway that does not require advanced airway skills, and decreasing the risk of intubation procedural complications.…”

Comparison of laryngeal mask airway and endotracheal tube in general anesthesia in children

“…External chest compressions are not affected during the operation, which can obtain valuable rescue time for patients with cardiac and respiratory arrest without exposing the larynx and glottis, thus reducing the difficulty of the operation ( 36 ). The laryngeal mask airway has a prominent role in opening and clearing the airway, absorbing the phlegm quickly and preventing air leakage ( 37 ).…”

Time to Effective Ventilation in Neonatal Manikins with a Supraglottic Airway vs. a Facemask: A Randomized Controlled Trial

“…If PPV is ineffective despite corrective measures, it is recommended to then switch the ventilation interface to an endotracheal tube (ETT) or supraglottic airway such as the laryngeal mask airway (LMA). However, there is growing interest and evidence to support the use of the LMA as a first-line interface for PPV [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”