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

Abstract

In neonatal resuscitation, Laryngeal Mask Airway (LMA) is usually recommended as an alternate airway when endotracheal intubation is not possible. However, it can be used to give positive pressure breaths in place of Bag and Mask (BM) and may even be easier to use than the latter. A study was undertaken to determine if the use of LMA as a primary mode of giving positive pressure breaths decreased the duration of positive pressure ventilation in neonates requiring resuscitation in delivery room. Methodology: 67 babies > 36 weeks and > 2000 gms requiring resuscitation at birth were quasi-randomized into two groups - BM or LMA - as the primary mode of administering positive pressure breaths. Resuscitation was as per standard protocols. 6 trained Resident doctors in their 2 nd or 3 rd year of residency performed the resuscitation in all cases. Primary outcomes were required for positive pressure ventilation in the first 5 minutes and for endotracheal intubation. Secondary outcomes were the duration of hospital stay and mortality. Results : Birth weight and gestational age were similar in both groups. Requirement of positive pressure ventilation (in seconds) in the first 5 minutes was less in the LMA group (95.31 (23.22) vs. 180.86 (37.83) secs), as was the number of babies who needed endotracheal intubation (5/32 vs. 12/35). There was no difference in the duration of hospital stay or mortality in the two groups. There were no complications noted with the use of LMA. Conclusion: LMA is safe and efficacious in neonatal resuscitation and appears to decrease the duration of resuscitation.