Alternative ventilation strategies: laryngeal masks

A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation

OBJECTIVE

To study the feasibility, efficacy and safety of using the laryngeal mask airway (LMA) in neonatal resuscitation.

METHODS

In total, 369 neonates (gestational age ≥ 34 weeks, expected birth weight ≥2.0 kg) requiring positive pressure ventilation at birth were quasi-randomised to resuscitation by LMA (205 neonates) or bag-mask ventilation (164 neonates).

RESULTS

(1) Successful resuscitation rate was higher with the LMA compared with bag-mask ventilation (P<0.001) and the total ventilation time was shorter with the LMA than with bag-mask ventilation (P<0.001). Seven of nine neonates with an Apgar score of 2 or 3 at 1 min after birth were successfully resuscitated in the LMA group, while in the BMV group all six neonates with an Apgar score of 2 or 3 at 1 min required tracheal intubation and ventilation. In neonates with an Apgar score of 4 or 5 at 1 min after birth, successful resuscitation rate with the LMA was higher than with bag-mask ventilation (P<0.01). (2) Successful insertion rate of the LMA at the first attempt was 98.5% and the insertion time was 7.8 s ± 2.2 s. There were few adverse events (vomiting and aspiration) in the LMA group.

CONCLUSION

The LMA is safe, effective and easy to implement for the resuscitation of neonates with a gestational age of 34 or, more weeks.

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

Background

Studies 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).

Methods

A 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.

Results

The 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.

Conclusions

Further studies are warranted to test the advantages and limits of the neonatal LMA training courses in developing countries.

Ventilation strategies in the depressed term infant

The transition from intrauterine to extrauterine life requires the lungs to change from being fluid-filled to air-filled and for regular, spontaneous respiration to become established. Many infants do not achieve this transition promptly without assistance and are given some form of artificial ventilation. Professional guidelines advocate the establishment of effective ventilation as the primary objective in the management of the apneic or bradycardic newborn infant in the delivery room. Considering the frequency with which neonatal resuscitation is performed, and the variety of devices available for resuscitating newly born infants, there have been relatively few prospective, randomized, clinical studies in newborns on which to base recommendations for practice. Much of the information comes from small case series, studies performed in asphyxiated or immature animals, and in-vitro tests.

Neonatal resuscitation--an analysis of the transatlantic divide

AIM

To highlight the main differences between the current editions of the Newborn Life Support (NLS; Resuscitation Council, UK) and the Neonatal Resuscitation Program (NRP; American Academy of Pediatrics and American Heart Association), and to analyse differences between the evidence underlying NLS and NRP.

MATERIAL AND METHODS

We undertook a detailed comparison of recommendations and references, based on the NLS and the NRP provider course manuals issued in 2006. Literature on neonatal resuscitation, published in 2005 and thereafter, was searched, focusing on controversies between NLS and NRP.

RESULTS

A multitude of important differences between NLS and NRP have been reaffirmed in their current editions, leading to conflicting messages regarding many aspects of resuscitation. An incongruent selection of evidence appears to be a major factor accounting for this divergence.

CONCLUSION

To avoid confusion among health care providers and to support the credibility of both NLS and NRP, an intensified dialogue and a more congruent evidence base between NRP and NLS is required. Mutual recognition of equivalency appears unrealistic until substantial progress in this direction has been achieved.