Laryngeal mask in the delivery room for neonates with difficult airway: a randomized clinical simulation study

Introduction. Endotracheal intubation is one of the most important technical skills in neonatal resuscitation. However, it can be challenging in various situations. The use of the laryngeal mask (LM) may be an alternative. However, its use is not yet standardized in current neonatal resuscitation algorithms. The study aimed to evaluate whether the standardized use of an LM in difficult airway (DAW) situations reduces the time to achieve effective ventilation (EVT) in a clinical simulation setting. Population and methods. This was a blinded, randomized, simulation-based study. A modified algorithm was developed that emphasized the early use of LM in cases of DAW. Two groups of neonatologists were randomly assigned to receive training in two different resuscitation algorithms (standard and modified). After training, the physicians participated in two simulation scenarios, one with a normal airway and one with a difficult airway. Results. Sixty-nine neonatologists participated in the study, 36 in the intervention group. No significant differences in EVT were observed between the two groups. However, when we analyzed those participants who used the LM on the first attempt, regardless of the training received, a shorter time was observed: 9.5 seconds (IQR 7-11) versus 63 seconds (IQR 42-89); p <0.01. Conclusions. Standardized use of LM in DAW situations could reduce the time to achieve effective ventilation.