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Updated: Jun 6, 2026
Laryngeal Mask Airway (LMA) Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway (SGA)
Published on: July 14, 2023
Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study
M B Tracy1, J Klimek, H Coughtrey
1Nepean Neonatal Intensive Care Unit, Nepean Hospital, Derby Street Kingswood 2747, Penrith 2751 Sydney, Australia. mark.tracy@ozemail.com.au
Aim:
To compare a new two-person method (four hands) of delivering mask ventilation with a standard one-person method using the Laerdal self-inflating bag (SIB) and the Neopuff (NP) infant resuscitator in a manikin model.
Background:
Recent studies of simulated neonatal resuscitation using bag and mask ventilation techniques have shown facemask leak levels of 55-57% in expert hands.
Methods:
48 participants were randomly paired and instructed to give mask ventilation for a 2-min period as single-person resuscitators, then as two-person paired resuscitators at set pressures for NP and set parameters for SIB. Airway pressure, flow, inspiratory tidal volume, expiratory tidal volume and mask leak were recorded.
Results:
A total of 21 578 inflations were recorded and analysed. For SIB, mask leak was greater (11.5%) with single-person compared to two-person (5.4%; mean difference 6.1%, 95% CI 1.5 to 10.7, p<0.01). For NP, mask leak was greater for single-person (22.2%) compared to two-person (9.1%; mean difference 13.1% 95% CI 3.6 to 22.6, p<0.01). For single-person mask ventilation, mask leak was greater with NP (22.2%) compared to SIB (11.5%; mean difference 10.7%, 95% CI 1.4 to 19.7, p<0.01). For two-person mask ventilation, mask leak was greater for NP (9.1%) compared to SIB (5.4%; mean difference 3.7%, 95% CI 0.1 to 6.4, p<0.05).
Conclusions:
Two-person mask ventilation technique reduces mask leak by approximately 50% compared to the standard one-person mask ventilation method. NP mask ventilation has higher mask leak than Laerdal SIB for both single- and two-person technique mask ventilation.
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