Preterm Supraglottic Airways Succeed in Neonatal Resuscitation Simulations

Advanced airway management for preterm infants is limited. Supraglottic airway devices may provide an alternative when face-mask ventilation fails or intubation is not feasible. Preterm-sized devices are now accessible. This study aimed to evaluate ventilation outcomes in manikins to determine whether progression to clinical testing is warranted.

This observational manikin study included healthcare workers at Sachs Children and Youth Hospital, Stockholm, Sweden, in March 2022. Insertion time, success rates, mask leakage, ventilatory rate, tidal volumes, and airway pressures were assessed using three manikins (2200, 950, 500 g) with one commercially available device (i-gel size 1) and three prototype sizes (neo-i-gel 0.85, 0.75, 0.65). Mask leakage was categorised as good (< 25%), acceptable (25%-49%), or unacceptable (≥ 50%). Participant satisfaction was recorded using a Likert scale.

Across 243 sessions conducted by nine physicians and 18 nurses, optimal device sizes were 0.85 for the 2200 g and 950 g manikins, and 0.75 for the 500 g manikin, based on mask leakage and tidal volume performance. High insertion success and consistent ventilatory rates were found. Participant satisfaction was positive.

Preterm-sized supraglottic airway devices appeared feasible for simulated neonatal resuscitation. Further clinical studies are urgently needed to validate their safety and effectiveness in clinical practice.