Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda

Nicolas J Pejovic, Daniele Trevisanuto, Clare Lubulwa, Susanna Myrnerts Höök, Francesco Cavallin, Josaphat Byamugisha, Jolly Nankunda, Thorkild Tylleskär, Nicolas J Pejovic, Daniele Trevisanuto, Clare Lubulwa, Susanna Myrnerts Höök, Francesco Cavallin, Josaphat Byamugisha, Jolly Nankunda, Thorkild Tylleskär

Abstract

Objective: Mortality rates from birth asphyxia in low-income countries remain high. Face mask ventilation (FMV) performed by midwives is the usual method of resuscitating neonates in such settings but may not always be effective. The i-gel is a cuffless laryngeal mask airway (LMA) that could enhance neonatal resuscitation performance. We aimed to compare LMA and face mask (FM) during neonatal resuscitation in a low-resource setting.

Setting: Mulago National Referral Hospital, Kampala, Uganda.

Design: This prospective randomised clinical trial was conducted at the labour ward operating theatre. After a brief training on LMA and FM use, infants with a birth weight >2000 g and requiring positive pressure ventilation at birth were randomised to resuscitation by LMA or FM. Resuscitations were video recorded.

Main outcome measures: Time to spontaneous breathing.

Results: Forty-nine (24 in the LMA and 25 in the FM arm) out of 50 enrolled patients were analysed. Baseline characteristics were comparable between the two arms. Time to spontaneous breathing was shorter in LMA arm than in FM arm (mean 153 s (SD±59) vs 216 s (SD±92)). All resuscitations were effective in LMA arm, whereas 11 patients receiving FM were converted to LMA because response to FMV was unsatisfactory. There were no adverse effects.

Conclusion: A cuffless LMA was more effective than FM in reducing time to spontaneous breathing. LMA seems to be safe and effective in clinical practice after a short training programme. Its potential benefits on long-term outcomes need to be assessed in a larger trial.

Clinical trial registry: This trial was registered in https://ichgcp.net/clinical-trials-registry/NCT02042118" title="See in ClinicalTrials.gov">NCT02042118.

Keywords: Asphyxia Neonatorum; Global Health; Laryngeal Masks; Newborn Infant; Resuscitation.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
The i-gel and face mask.
Figure 3
Figure 3
Mean heart rate (bpm).

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