Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask

Pejovic, Nicolas J; Cavallin, Francesco; Mpamize, Allan; Lubulwa, Clare; Höök, Susanna Myrnerts; Byamugisha, Josaphat; Nankunda, Jolly; Tylleskär, Thorkild; Trevisanuto, Daniele

doi:10.1016/j.resuscitation.2021.10.025

Cited by 7 publications

(3 citation statements)

References 43 publications

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“…However, a recent sub-study of the NEOSUPRA trial found that the mask leak was similar between i-gel (cuffless SGAD) and FM. The expired tidal volume, peak inspiratory pressure, and inspiratory tidal volume were similar between the FM and i-gel [25]. Airway resistance is inversely related to the fourth power of the airway radius.…”

Section: Lm and Its Effect On Respiratory Mechanicsmentioning

confidence: 74%

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

2022

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Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.

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Section: Lm and Its Effect On Respiratory Mechanicsmentioning

confidence: 74%

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

2022

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“…The SysRev identified 5 RCTs [227][228][229][230][231] and 1 quasi-RCT 232 involving a total of 1857 newborn infants and 2 retrospective cohort studies 233,234 involving 218 newborn infants. An additional study 235 reported secondary outcomes from a subset of newborn infants enrolled in an included RCT. 228 Meta-analysis results are shown in Table 27.…”

Section: Consensus On Sciencementioning

confidence: 99%

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

Wyckoff¹,

Greif²,

Morley³

et al. 2022

Circulation

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This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

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“…Time to spontaneous breathing and ventilation time: Of the 560 infants included from three studies,15 17 19 the time to spontaneous breathing was shorter in the LMA group with a mean difference of −4.40 s (95% CI −15.2 to 6.49, I 2 −75%). Ventilation time was reported in five studies15 17–19 23 (one study23 was substudy of Pejovic et al 16 so data were extracted only for ventilation time). A total of 656 babies were included showing a mean difference of −20.12 s (95% CI −54.7 to 14.5, I 2 −93%) favouring LMA.…”

Section: Resultsmentioning

confidence: 99%

Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis

Diggikar

Krishnegowda

Nagesh

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo assess whether laryngeal mask airway (LMA) as compared with face mask (FM) or endotracheal intubation (ETT) is more effective in delivering positive pressure ventilation (PPV) during neonatal resuscitation in low-and-middle income countries (LMICs).Study designWe followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and searched Medline (PubMed interphase), Cumulative Index of Nursing and Allied Health Literature, Embase and Cochrane Registry between January 1990 and April 2022 for the studies that examined the effect of LMA in delivering PPV compared with the FM or ETT in infants during neonatal resuscitation. We included the studies conducted in LMIC only. We assessed the quality of all the included studies using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) recommendations.ResultsOur search resulted in eight randomised studies Six studies compared LMA with FM and three studies compared LMA with ETT. When used as the primary device for providing PPV, the LMA as compared with FM resulted in a significant lower failure rate (relative risk (RR) 0.23, 95% CI 0.13 to 0.43) with moderate certainty of evidence (CoE) and lesser need for intubation (RR 0.21, 95% CI 0.07 to 0.58) with low CoE. There was no difference in the incidence of encephalopathy, neonatal admission, need for advanced resuscitations or death. No differences were observed between LMA and ETT. Studies comparing LMA to ETT were limited for any conceivable conclusion.ConclusionLMA is more effective than FM in delivering PPV with less failure rates and reduced need for intubation during neonatal resuscitation in term infants and in LMIC without any difference in the incidence of encephalopathy or death. Studies comparing LMA to ETT are scarce with important methodological limitations.PROSPERO registration numberCRD42021283478.

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Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask

Cited by 7 publications

References 43 publications

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

Laryngeal Masks in Neonatal Resuscitation—A Narrative Review of Updates 2022

Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis

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