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Supraglottic Airways for Neonatal Resuscitation NLS #5340

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This CoSTR is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final COSTR will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: None.

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees:

One author (GMW) was co-author of one of the included observational studies. He was excluded from bias assessment of this study.

One author (DT) was co-author of 3 included randomized trials and both included observational studies. He was excluded from bias assessment of these studies.

Both acknowledged their potential intellectual conflicts of interest and participated in the Task Force discussion of the consensus on science and treatment recommendations.

CoSTR Citation

Yamada NK, McKinlay CJD, Quek BH, Rabi Y, Costa-Nobre DT, de Almeida MF, Davis PG, El-Naggar W, Fabres JG, Fawke J, Foglia EE, Guinsburg R, Hosono S, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Lee H, Liley HG, Madar RJ, Nakwa FL, Perlman JM, Roehr CC, Rüdiger M, Schmölzer GM, Sugiura T, Trevisanuto D, Wyckoff MH, Wyllie JP, Weiner GM. Supraglottic airways for neonatal resuscitation (NLS#618/5340 [Internet] Brussels, Belgium. International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force, Available from http://ilcor.org

Methodological Preamble (and Link to Published Systematic Review)

This PICOST was prioritized by the Neonatal Life Support Task Force because the question had not been updated since 2015, the previous CoSTR had focused on the use of supraglottic airways compared with endotracheal intubation, and the Task Force was interested in evaluating the use of a supraglottic airway as the initial device for positive-pressure ventilation because of the high risk of leak and obstruction when using a face mask. The Task Force was aware that additional randomized trials comparing a supraglottic device and face mask as the initial device for positive-pressure ventilation had been completed since the previous review. The continuous evidence process for the creation of Consensus of Science and Treatment Recommendations (CoSTR) started with a systematic review of supraglottic devices (Yamada, 2021 PROSPERO 2021 CRD42021230722) conducted by Nicole Yamada, Christopher McKinlay, Bin Huey Quek, and Gary Weiner. Evidence from neonatal literature was sought and considered by the Neonatal Life Support Task Force and clinical content experts. These data were taken into account when formulating the Treatment Recommendations.

Systematic Review

Reference not yet available

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs, and Time Frame)

Population: Newborn infants 34 0/7 weeks’ or more gestation receiving intermittent positive-pressure ventilation during resuscitation immediately after birth

Intervention: Supraglottic airway

Comparator: Face mask

Outcomes: Failure to improve with the device (as defined by authors), intubation during initial resuscitation, time to heart rate >100 beats per minute (bpm) during initial resuscitation, duration of positive pressure ventilation during initial resuscitation, time to cessation of positive pressure ventilation, chest compressions or epinephrine (adrenaline) administration during initial resuscitation, soft tissue injury (as defined by authors), admission to neonatal intensive care unit (NICU), air leak during the initial hospital stay (presence of pneumothorax, pneumomediastinum, pulmonary interstitial emphysema, or pneumopericardium), survival to hospital discharge, neurodevelopmental impairment at ≥ 18 months (abnormal motor, sensory or cognitive function, or low educational achievement at ≥18 months of age using an appropriate, standardized test or examination).

Outcomes ratings using the GRADE classifications of critical or important were based on a consensus for international neonatal resuscitation guidelines (range 1-3 low importance for decision-making, 4-6 important but not critical for decision-making, 7-9 critical for decision-making). {Strand 2020 328} Potential subgroups (late preterm and cuffless supraglottic device) were defined a priori. Outcomes were converted into main outcomes and additional outcomes for submission to PROSPERO. All included randomized controlled trials (RCTs) and quasi-randomized RCTs (quasi-RCTs) allowed cross-over between devices if the subject did not respond to the initial randomized device. If cross-over occurred, outcomes were measured and assigned to the initial device (intent-to-treat principle). If necessary, study authors were contacted to request missing data. Missing standard deviations (SD) were either imputed following the guidelines outlined in the Cochrane Handbook or estimated. {Wan 2014 135}

Study Designs: RCTs, quasi-RCTs, and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) were eligible for inclusion. Quasi-RCTs were included with RCTs in meta-analyses. Unpublished studies (e.g., conference abstracts, trial protocols) were excluded. Outcomes from observational studies were assessed if there were fewer than 2 included RCTs/quasi-RCTs or if the certainty of evidence from RCTs/quasi-RCTs was scored very low.

Timeframe: All years and all languages were included as long as there was an English abstract. The literature search was updated to December 9, 2021.

PROSPERO registration:

The review was registered with PROSPERO CRD42021230722.

Risk of Bias:

Risk of bias (RoB) was assessed by outcome using the Cochrane ROB2 tool {Sterne 2019 366} for RCTs and quasi-RCTs, and the ROBINS-I tool {Sterne 2016 355} for observational studies. RoB for each outcome was summarized across studies. Statistical heterogeneity was considered present if the I2 statistic was >50%. We attempted to explain statistical heterogeneity using sensitivity analyses. Imprecision was considered present if the total number of participants included was less than optimal information size (OIS) for the outcome under consideration. OIS was calculated as the sample size required for a single, adequately powered RCT (alpha 0.05, beta 0.80, control event rate equal to the pooled event rate in the face mask group, effect size = relative risk 0.75 or 1 SD). {Dupont 1974 274}

Overall, study-level RoB was high. All studies were at high RoB for lack of blinding of participants and personnel due to the nature of the intervention and for lack of blinding of outcome assessors for many outcomes.

All outcomes selected for GRADE assessment, except failure to improve with the device, were rated as low or very low certainty evidence. For most outcomes, this uncertainty was attributable to high RoB and imprecision.

Consensus on Science

COMPARISON: Supraglottic airway compared with face mask ventilation for positive-pressure ventilation during resuscitation immediately after birth

The systematic review identified 5 RCTs {Feroze 2008 148; Pejovic 2018 255; Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286} and 1 quasi-RCT {Zhu 2011 1405} involving a total of 1857 newborn infants, and 2 retrospective cohort studies {Trevisanuto 2004 151; Zanardo 2010 327} involving 218 newborn infants. An additional study {Pejovic 2021 pg # pending} reported secondary outcomes from a subset of newborn infants enrolled in an included RCT {Pejovic 2020 2138}.

For the important outcome of failure to improve with the device, evidence of moderate certainty (downgraded for risk of bias and imprecision, upgraded for strong association) from 6 trials {Feroze 2008 148; Pejovic 2018 255; Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286; Zhu 2011 1405} involving 1823 newborn infants showed probable benefit from receiving positive-pressure ventilation with a supraglottic airway compared to a face mask (risk ratio (RR) 0.24; 95% confidence interval (CI) 0.17 to 0.36; p <0.001; I2 = 35%; Absolute risk difference (ARD) -11%, 95% CI -13% to -8%; NNT= 10).

For the important outcome of endotracheal intubation during resuscitation, evidence of low certainty (downgraded for risk of bias, inconsistency, and imprecision; upgraded for strong association) from 4 trials {Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286; Zhu 2011 1405} involving 1715 newborn infants showed possible benefit from receiving positive-pressure ventilation with a supraglottic airway compared to a face mask (RR 0.34, 95% CI 0.20 to 0.56; p <0.001; I2=78%; ARD -5%, 95% CI -6% to -3%; NNT 20). In sensitivity analysis, heterogeneity was not significantly decreased and the benefit remained (RR 0.19, 95% CI 0.09 to 0.37; p < 0.001; I2 = 63%) after removing the study {Pejovic 2020 2138} where intubation was only possible if a physician was available during the resuscitation. Heterogeneity was decreased and the risk reduction was no longer statistically significant (RR 0.65, 95% CI 0.36 to 1.19; p=0.17; I2 =45%) when the single quasi-RCT {Zhu 2011 1405} was removed.

For the critical outcome of chest compressions during resuscitation, evidence of low certainty (downgraded for risk of bias and imprecision) from 3 trials {Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286} involving 1346 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.97, 95% CI 0.57 to 1.65; p=0.91; I2=0%; ARD 1/1000 fewer newborn infants with chest compressions when receiving positive-pressure ventilation with a supraglottic airway, 95% CI 17/1000 fewer to 26/1000 more).

For the critical outcome of epinephrine (adrenaline) administration during resuscitation, evidence of low certainty (downgraded for risk of bias and imprecision) from 2 trials {Singh 2005 303; Trevisanuto 2015 286} involving 192 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.67, 95% CI 0.11 to 3.87; p=0.65; I2 not applicable; ARD 10 /1000 fewer newborn infants receive epinephrine (adrenaline) when receiving positive-pressure ventilation with a supraglottic airway, 95% CI 28/1000 fewer to 90/1000 more). Statistical heterogeneity could not be calculated because events occurred in only one trial {Trevisanuto 2015 286}.

For the important outcome of time to heart rate >100 bpm, evidence of low certainty (downgraded for risk of bias and imprecision) from 1 trial {Pejovic 2021 pg # pending} involving a subset of 46 newborn infants enrolled in a previously reported RCT {Pejovic 2020 2138} showed possible benefit from receiving positive-pressure ventilation with a supraglottic airway compared to a face mask (mean difference -66 s, 95% CI -100 s to -31 s; p<0.001)

For the important outcome of duration of positive-pressure ventilation, evidence of low certainty (downgraded for risk of bias and inconsistency) from 4 trials {Pejovic 2018 255; Singh 2005 303; Trevisanuto 2015 286; Zhu 2011 1405} involving 610 newbor infnats showed possible benefit from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (mean difference -18 s, 95% CI -24 s to -13 s; p < 0.001; I2 = 94%. In sensitivity analysis, all of the heterogeneity was attributed to one study {Trevisanuto 2015 286}. This may reflect a different protocol or policy, in this single center trial, for when to remove the supraglottic airway and discontinue positive-pressure ventilation. When removing this study, the beneficial effect was retained and statistical heterogeneity was significantly reduced (mean difference -30s, 95% CI -36 s to -24 s; p < 0.001; I2 = 0%).

For the important outcome of admission to the NICU, evidence of very low certainty (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 4 trials {Pejovic 2018 255; Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286} involving 1314 newborn infants showed possible benefit and no likely harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.97, 95% CI 0.94 to 1.00; p=0.07; I2=82%; ARD -3%, 95% CI -5% to 0%; NNT 34). In sensitivity analysis, all of the heterogeneity was attributed to the high rate of admission to the NICU (96% in both groups) in one study {Pejovic 2020. 2138}. This may reflect heterogeneity in the population studied (sicker newborns) or in the policies/protocols for intensive care admission in this single center trial. When this study was removed, the treatment effect was increased and heterogeneity was significantly decreased (RR 0.60, 95% CI 0.40 to 0.90, p=0.01; I2 =0%).

For the important outcome of admission to the NICU, evidence of very low certainty (downgraded for risk of bias, indirectness, and imprecision) from 2 retrospective cohort studies {Trevisanuto 2004 151; Zanardo 2010 327} involving 218 newborn infants showed possible benefit and no likely harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.65, 95% CI 0.43 to 1.00; p=0.05; I2 =36%; ARD -13%; 95% CI -25% to 0%).

For the important outcome of air leak during initial hospital stay, evidence of very low certainty (downgraded for risk of bias, indirectness, and imprecision) from 2 trials {Singh 2005 303; Trevisanuto 2015 286} involving 192 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR not estimable due to no events; I2=0%; ARD 0%, 95% CI -3% to 3%).

For the important outcome of air leak during initial hospital stay, evidence of very low certainty (downgraded for risk of bias, indirectness, and imprecision) from 2 retrospective cohort studies {Trevisanuto 2004 151; Zanardo 2010 327} involving 218 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.32, 95% CI 0.05 to 1.99; p=0.22; I2=0%; ARD -3%, 95% CI -7% to 1%).

For the important outcome of soft tissue injury, evidence of low certainty (downgraded for risk of bias and imprecision) from 4 trials {Pejovic 2020 2138; Singh 2005 303; Trevisanuto 2015 286; Zhu 2011 1405} involving 1724 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 1.05, 95% CI 0.15 to 7.46; p=0.96; I2 not applicable; ARD 0/1000 fewer newborn infants with soft tissue injury when receiving positive-pressure ventilation with a supraglottic airway, 95% CI 2/1000 fewer to 15/1000 more). Statistical heterogeneity could not be calculated for this outcome because there were no events recorded in 3 of 4 included studies. Soft tissue injury (2 events in each group) only occurred in one study {Pejovic 2020 2138}.

For the critical outcome of survival to hospital discharge, evidence of low certainty (downgraded for risk of bias and imprecision) from 1 trial {Singh 2005 303} involving 50 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 1.00; 95% CI 0.93 to 1.08; p=1.0; I2 not applicable; ARD, 0/1000 fewer newborn infants survive when receiving positive-pressure ventilation with a supraglottic airway, 95% CI 70/1000 fewer to 80/1000 more).

For the critical outcome of survival to hospital discharge, evidence of low certainty (downgraded for risk of bias and imprecision) from 2 retrospective cohort studies {Trevisanuto 2004 151; Zanardo 2010 327} involving 218 newborn infants could not exclude benefit or harm from providing positive-pressure ventilation with a supraglottic airway compared with a face mask (RR 0.99; 95% CI 0.96 to 1.02; p=0.58; I2=0%; ARD 10/1000 fewer newborn infants survive when receiving positive pressure ventilation with a supraglottic airway, 95% CI 40/1000 fewer to 20/1000 more).

For the critically important outcome of neurodevelopmental impairment at ≥18 months of age, no data were reported in the included studies.

Subgroup Analyses:

No data were reported to perform prespecified subgroup analyses by gestational age (term vs. late preterm).

For the planned subgroup analysis based on device design (cuffed device vs. uncuffed (i-Gel™) device), “failure to improve with the device” was the only outcome with sufficient data to analyze, and there was no evidence of an interaction (p = 0.29, I2 = 10%).

Treatment Recommendations

Where resources and training permit, we suggest that a supraglottic airway may be used in place of a face mask for newborn infants 34 0/7 weeks’ or more gestation receiving intermittent positive pressure ventilation during resuscitation immediately after birth (weak recommendation, low certainty of evidence).

Justification and Evidence to Decision Framework Highlights

In making these recommendations, the Neonatal Life Support Task Force acknowledges the following:

Supraglottic airways compared with face masks may be more effective in achieving successful resuscitation of late preterm and term newborn infants who receive positive pressure ventilation immediately after birth.

Although “failure to improve with device” was variously defined by authors, and often included cross-over to the alternative device, there was a strong inverse association between the use of a supraglottic airway and risk of endotracheal intubation. This may reflect a greater likelihood of achieving effective ventilation using the supraglottic airway. Nevertheless, given that the interventions were not blinded, and ability to intubate in the largest trial was dependent on physician availability, there are risks of differential co-interventions and other biases. Furthermore, optimal information size was not achieved for any of the critical or important pre-specified outcomes except duration of positive-pressure ventilation. Therefore, further trials are needed before stronger recommendations can be made about use of supraglottic airways as the initial device for positive pressure ventilation.

Balancing factors in the Task Force recommendation include the training required for supraglottic airway insertion and the safety of the supraglottic airway compared with face mask ventilation. Although the training provided was incompletely documented in several studies {Feroze 2008 148; Singh 2005 303; Zhu 2011 1405} and no study compared the effectiveness of different training programs, successful insertion of the supraglottic airway was high despite apparently short-duration training with a manikin. In the largest trial {Pejovic 2020 2138}, participating midwives received brief didactic training for insertion of a cuffless supraglottic device as part of a Helping Babies Breathe course and were required to demonstrate 3 successful insertions in a maninkin before participating in the study. Only 2 RCTs {Singh 2005 303; Trevisanuto 2015 286} indicated that successful insertion in a newborn infant was a prerequisite to study participation. While the individual studies had limited power to establish the safety of the supraglottic airway, the Task Force was encouraged by the relatively large number of newborn infants reported across all studies and the small number of adverse events.

Neither the cost of supplying supraglottic airways in the delivery room nor the cost-effectiveness of providing positive-pressure ventilation with a supraglottic airway compared with a face mask has been studied. In 5 of the included studies {Pejovic 2018 255; Pejovic 2020 2138; Trevisanuto 2015 286; Zhu 2011 1405}, the authors indicated that the device was provided as part of the study. The availability of resources and economic considerations may influence the decision whether to use a supraglottic airway or face mask. Given the large number of infants worldwide who receive positive pressure ventilation after birth, it is important to evaluate the cost-effectiveness of the supraglottic airway as the initial device for positive pressure ventilation.

Knowledge Gaps

The training requirements to achieve and maintain competency with supraglottic airway insertion, including different types of devices.

The effectiveness and safety of supraglottic airways as the initial device for positive-pressure ventilation in high resource settings.

The effectiveness and safety of supraglottic airways compared with face masks during chest compressions.

The effectiveness and safety of supraglottic airways compared with face masks for newborn infants with orofacial anomalies.

The effectiveness and safety of different supraglottic airway designs.

The effectiveness and safety of supraglottic airways for positive-pressure ventilation among newborn infants less than 34 weeks’ gestation.

The resource utilization and cost-effectiveness of using supraglottic airways compared with face masks as the initial device for positive-pressure ventilation in different settings.

Attachments: NLS 5340 Supgraglottic airway Et D

References

  1. Dupont WD and Plummer WD: PS power and sample size program available for free on the Internet. Controlled Clin Trials,1997;18:274
  2. Feroze F, Masood N, Khuwaja A, Llyas F. Neonatal resuscitation: The use of laryngeal mask airway. Professional Medical Journal 2008; 15(1):148-152.
  3. Pejovic NJ, Trevisanuto D, Lubulwa C, Myrnerts Höök S, Cavallin F, Byamugisha J, Nankunda J, Tylleskär T. Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda. Arch Dis Child. 2018; 103(3):255-260.
  4. Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Blennow M, Trevisanuto D, Tylleskär T. A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation. N Engl J Med 2020; 383(22):2138-2147.
  5. Pejovic NJ, Cavallin F, Mpamize A, Lubulwa C, Hook SM, Byamugisha J, et al. Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask. Resuscitation. 2021.
  6. Singh R, Mohan CVR, Taxak S. Controlled trial to evaluate the use of LMA for neonatal resuscitation. J Anaesth Clin Pharmacol 2005; 21(3):303-306.
  7. Strand ML, Simon WM, Wyllie J, Wyckoff MH, Weiner G. Consensus outcome rating for international neonatal resuscitation guidelines. Arch Dis Child Fetal Neonatal Ed. 2020;105:328-330.
  8. Trevisanuto D, Micaglio M, Pitton M, Magaratto M, Piva D, Zanardo V. Laryngeal mask airway: Is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004; 62(2):151-157.
  9. Trevisanuto D, Cavallin F, Nguyen LN, Nguyen TV, Tran LD, Tran CD, Doglioni N, Micaglio M, Moccia L. Supreme laryngeal mask airway versus facemask during neonatal resuscitation: A randomized controlled trial. J Pediatr. 2015; 167(2):286-91.e1.
  10. Wan X, Wang W, Liu J, et al. (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14, 135.
  11. Zanardo V, Weiner G, Micaglio M, Doglioni N, Buzzacchero R, Trevisanuto D. Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway. Resuscitation 2010; 81(3):327-330.
  12. Zhu XY, Lin BC, Zhang QS, Ye HM, Yu RJ. A prospective evaluation of the efficacy of the laryngeal mask airway during neonatal resuscitation. Resuscitation 2011; 82(11): 1405-1409.

supraglottic airway

Discussion

GUEST
Associate Professor Alsweiler
Nicely written review, I agree with the recommendation.
Reply
GUEST
Giselda Silva
we use the laryngeal mask in preterm infants over 34 weeks with intubation difficulty only
Reply
GUEST
Nicole Udsen Luis
We use supraglottic device only in difficult airway at the moment. The recommendation has interesting points, I beleive failure to correctly ventilate with face masks can be one of the reasons of needing to intubate and that may possibly be corrected with supraglottic devices.
Reply
GUEST
LEONARDO SIQUEIRA
Nowadays we are using baby puff at newborns under 37 weeks following ressuscitation principles.
Reply
GUEST
Camilla Tovar
In our reality, the laryngeal mask still does not have an appropriate space! Considering that one of the main reasons for tracheal intubation during resuscitation is failure of mask ventilation, investing in training in laryngeal mask ventilation could actually reduce the number of intubations in over 34 weeks!
Reply
GUEST
Nadia Sandra Orozco Vargas
I agree!!!! Congratulations!!!
Reply
GUEST
Roque Antonio Foresti
We do not use a laryngeal mask in the delivery room. Except difficult intubations.
Reply
GUEST
Gabriel Variane
We are currently utilizing the supraglottic device in our center to assess difficult airways only. If mask ventilation is ineffective and the center has the necessary resources and trained staff, the supraglottic device could be used. This could reduce the number of intubated infants in the delivery room.
Reply
GUEST
Ilana Egypto
In our reality, the laryngeal mask still does not have an appropriate space!
Reply
GUEST
Gislayne Nieto
We have no experience in our service. we use the laryngeal mask in new borns over 34 weeks with intubation difficulty only
Reply
GUEST
Janine Figueiredo
Considering that not all deliveries are assisted by pediatricians in our country and supraglotic devices are barely available, I’m concerned this recommendation may delay or compromise the effective resuscitation maneuvers by caregivers.
Reply
GUEST
Marcos Silva
The use of the larynx mask in our region is not a reality, as we do not have these supplies, even in resuscitation courses we do not have it to teach the proper handling by the students. But I believe it is an effective alternative in difficult incubation.
Reply
GUEST
MARINA CARVALHO DE MORAES BARROS
The use of the supraglottic device can be useful in ventilation in the delivery room in newborns with difficult airways, reducing the need for tracheal intubation, but it is necessary to train professionals in its use in Brazil.
Reply
GUEST
Natacha Hébert
I am a pediatrician in a community hospital… i am a bit surprised with this new recommendation as we too only used the laryngeal mask at the end of MR SOPA… the technique for inserting it is quite simple however… we may save quite a bit of time if we don’t have too worry as much about MR SOPA…?? Food for thought…
Reply
GUEST
Carmen Elias
I have no experience with a supraglottic airway.
Reply
GUEST
alessa mantovan
In my services we don’t use laryngeal mask as routine so my concern is about the correct use and not delay resuscitation But I believe it is an effective alternative in difficult airway.
Reply
GUEST
Patricia Mendes
I have no experience with supraglottic airway.
Reply
GUEST
Natália Silva
I think it is important that professionals who attend the delivery room are aware and trained for the devices they can use during care. The supraglottic device is a valid option for ventilation, especially in difficult airways, but robust studies are still lacking for a recommendation for routine use.
Reply
GUEST
Mônica Teixeira
3) Supraglottic airways might be beneficial in dificult Airways, but must have training during the courses of neonatal resuscitation, since most physicians don't use it very often.
Reply
GUEST
Racire Silva
I have no experience with this mask. It is not available on my service.
Reply
GUEST
Nadir Gomes de Barros Santos
Never used but has great merit and reanimariam courses should include this technique.
Reply
GUEST
MARIA ALBERTINA REGO
In Brazil, where intubation is a medical act, the supraglottic device is promising for non-medical professionals. With the results of observational studies, it will be important to assess the effectiveness of training programs.
Reply
GUEST
José Roberto Ramos
I believe that laryngeal mascara is an excellent tool option to help start breathing newborns. You will only need training in our country for proper use.
Reply
GUEST
Carmen Silvia Martimbianco de Figueiredo
Supraglottic device can be useful in ventilation in the delivery room in newborns with difficult airways. This device may reduce the need for tracheal intubation, is also useful in ineffective mask ventilation Unfortunately we do not have this device in our delivery room.
Reply
GUEST
Shamya Rached Bandeira
In our service we do not have a laryngeal mask; but I believe it would be very helpful to use in places where there are no experienced people in orotracheal intubation or in newborns with orotracheal malformations
Reply
GUEST
jos bruinenberg
Thanks for this recommendation which is in line with the culminating evidence. I am slightly worried however about the practical implications. After introducing the laryngeal mask airway, the next step would be to provide inflation breaths with a pressure of 30 cm H2O in a child>32 weeks of gestation, based on literature of the face mask. . It has not been evaluated if this pressure is the right pressure in case of a laryngeal mask airway. Due to less airwayleak and a position near the trachea, this might be an inappropriate high pressure leading to an increased change of pulmonary damage (pneumothorax, increased inflammation, etc.). So the recommendation of the facemask can not be transferred to another airwaymanagement device. I am interested in your response to this comment.
Reply
GUEST
Liza Edmonds
I think the recommendation for the use of supraglottic airways would be valuable if it is placed in the context of an escalation of care when unable to ventilate. My concerns would be that if this was nested in an escalation plan it might delay ventilation. Careful training and attention to detail usually results in the ability to ventilate. I think if this sat alongside a ventilation escalation it would work but separately there is the potential of the unintended consequence of poor ventilation
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