Supreme and classic laryngeal mask airway in neonatal resuscitation

Abstract

Objective To study the feasibility, efficacy and safety of laryngeal mask airway (LMA) Supreme (SLMA) in neonatal resuscitation. Methods Sixty neonates, who were born at South Medical University Affiliated Maternal & Child Health Hospital of Shenzhen from June 1, 2012 to June 1, 2013 and requiring positive pressure ventilation after 30 s primary resuscitation post born, with birth weight above 2 000 g or gestational age above 34 weeks, were randomly assigned into two groups: SLMA group (n=30) and LMA Classic (CLMA) group (n=30). The outcome indicators included the curative effect, insertion time and possible adverse reactions of the two kinds of LMA, and the serum bio-markers, heart rate and percutaneous pulse oxygen saturation (SpO2) of all neonates. Independent sample t test, non-parametric test and Chi-square test were applied for statistical analysis. Results The insertion time was shorter in SLMA group than in CLMA group [(4.9±1.0) vs (7.6±1.3) s, t=8.98, P<0.05]. And more displacement occurred in CLMA group than in SLMA group [13.3% (4/30) vs 0% (0/30), Fisher exact test, P<0.05]. The successful rate of resuscitation in SLMA group was higher [100.0% (30/30) vs 90.0% (27/30), Fisher's exact test, P<0.05], and both the onset time and the total ventilation time were shorter than those in CLMA group [(12.4±3.7) vs (15.6±3.8) s, t=3.31, P<0.05; (37.3±17.0) vs (48.2±20.1) s, t=2.29, P<0.05]. The heart rate at 1 min after delivery was higher in SLMA group than in CLMA group [(93.5±20.9) vs (74.2±17.8) bpm, t=-3.86, P<0.05], and the same results were shown for SpO2 at 1, 2 and 3 min after birth [(47.1±8.4)% vs (38.7±12.1)%, t=-3.13; (68.1±9.5)% vs (52.8±10.8)%, t=-5.82; (78.3±10.0)% vs (72.1±9.7)%, t=-2.46; all P<0.05]. In the CLMA group, vomit or regurgitation occurred in three neonates, abdominal distension in two cases, aerogastria in seven cases. However, none of the above was reported in the SLMA group. No laryngeal injury was found in any of the subjects. Conclusion SLMA is more potential than CLMA in neonatal resuscitation because of its simplicity, better airtight, less adverse effect, superior efficacy and less requirement for tracheal intubation. Key words: Resuscitation; Positive-pressure respiration; Laryngeal masks; Infant, newborn