Laryngeal Mask Ventilation With Chest Compression During Neonatal Resuscitation – Randomized, Non-inferiority Trial in Lambs

BACKGROUND: Effective positive pressure ventilation is a critical factor in newborn resuscitation. Neonatal endotracheal intubation (ETT) needs considerable training and experience, which poses a human factor challenge. Laryngeal mask airway (LMA) ventilation can be a secure and viable alternative during the initial stages of newborn resuscitation. However, there is limited evidence for its use during chest compression (CC). METHODS: Seventeen lambs were randomized into LMA or ETT ventilation post cord occlusion induced cardiac arrest. After 5 minutes of cardiac arrest, resuscitation was initiated as per NRP recommendations. Ventilation, oxygenation, systemic and pulmonary hemodynamic parameters were recorded till return of spontaneous circulation (ROSC) or 20 minutes. RESULTS: Baseline characteristics were similar between the groups. The incidence of ROSC was 75% (6/8) in the LMA group and 56% (5/9) in the ETT group (p = 0.74). The median (IQR) time to achieve ROSC was 6.85 min (6 min – 9.1 min) in the LMA group and 7.50 min (5.33 min – 18 min) in the ETT group (p = 0.65). CONCLUSION: LMA ventilation during CC is feasible and non-inferior to ETT in this model.