The Laryngeal Mask: Empowering Nurses to Rescue Newborns

Since 2005, the Neonatal Resuscitation Program (NRP) has recommended the laryngeal mask (LM) as an alternative airway when positive-pressure ventilation (PPV) is unsuccessful and intubation is unsuccessful or unfeasible. There is a paucity of literature regarding LM use in high-resource countries; however, anecdotal information and recent studies suggest low implementation.

This article increases awareness of LM safety and efficacy, provides guidance for determining nursing scope of practice, and includes suggestions for developing a training program.

Methods include considering NRP customers' questions, recent systematic reviews of the literature, how NRP recommendations are developed, how to determine nursing scope of practice, and how to develop a training program.

Recent studies support the NRP recommendation to use the LM as a rescue airway when PPV fails and intubation is not feasible. The LM provides more effective PPV than face-mask ventilation. The LM may be effective as the initial PPV device for infants of at least 34 weeks' gestation. To use the LM, nurses may require training, which may include a simulation-based curriculum.

Nurses can increase their awareness of the advantages of LM use, determine their scope of practice, and develop a training program. When face-mask ventilation is unsuccessful and intubation is unfeasible, LM insertion will likely increase the newborn's heart rate and avoid intubation.

Future research should determine training requirements, efficacy of the LM as the initial PPV device in high-resource settings, and LM use during complex resuscitation and in preterm newborns.