Laryngeal Mask Airway: An Alternative for Neonatal Resuscitation in a US Safety-Net Hospital

In the delivery room, newborn respiratory failure precedes cardiac failure, emphasizing the importance of effective ventilation. Face masks for ventilation may cause air leakage around the mask with subsequent suboptimal lung pressure, and intubation requires skilled providers. Laryngeal mask airways (LMA) may provide a more stable airway interface, with improved seal and more consistent ventilation that is less dependent on provider technique. An evaluation of the feasibility, acceptability, and initial outcomes of implementing the laryngeal mask airway as the first-line approach for ventilation in late preterm and term infants was conducted in a high-resource, urban safety-net hospital with a level III neonatal intensive care unit (NICU).

The LMA was introduced and promoted as the firstline for delivery room ventilation in infants ≥35 weeks gestational age and ≥1.5 kg from August 2023 to August 2024. Implementation was supported by comprehensive training, survey feedback, and multidisciplinary involvement. The program evaluation spanned a 2-year period from August 2022 to August 2024. Feasibility and acceptability data were collected via provider surveys, and neonatal outcomes were compared pre- and post-implementation from electronic health record data.

During implementation, LMAs were used as first-line in 58.7% of eligible neonates indicated for delivery room ventilation. Provider surveys showed increased knowledge and confidence in LMA use after education and high comfortability with LMA implementation in the delivery room. NICU admission rates, delivery room endotracheal intubations, chest compressions, and epinephrine use were similar across groups.

Providers across experience levels successfully inserted LMAs after brief training. LMA as first-line ventilation yielded similar outcomes to face mask in an urban safety-net hospital. Future research should explore broader applicability.