Name: laryngeal mask airway (lma) placement in a neonatal patient simulator using a non-inflatable supraglottic airway (sga)
Uploaded: 2023-07-14T14:10:00
Description: Watch this Scientific Journal Video about Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA at JoVE.com

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. BAS is supported by the Oklahoma Shared Clinical and Translational Resources (U54GM104938) with an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences.

All methods described here have been approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center.
1. Placing a laryngeal mask
<ol>
	<li>Select appropriately sized SGA (newborn size 1 [2-5 kg]).</li>
	<li>Open the SGA. Remove the pack that holds the device.</li>
	<li>Open the pack. Transfer the SGA to the lid of the pack.</li>
	<li>Holding the integral bite block, apply a thin coat of lubricant to the back, sides, and the front of the SGA.
...

<ol>
	<li>Moshiro, R., Mdoe, P., Perlman, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+global+view+of+neonatal+asphyxia+and+resuscitation.">A global view of neonatal asphyxia and resuscitation.</a> Frontiers in Pediatrics. 7, 489 (2019).</li><li>McGuire, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perinatal+asphyxia.">Perinatal asphyxia.</a> BMJ Clinical Evidence. 2007, 320 (2007).</li><li>Gillam-Krakauer, M., Gowen, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Birth Asphyxia. , (2023).</li><li>Mini&#241;o, A. M., Heron, M. P., Smith, B. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laryngeal+mask+use+in+the+neonatal+population:+A+survey+of+practice+providers+at+a+regional+tertiary+care+center+in+the+United+States.">Laryngeal mask use in the neonatal population: A survey of practice providers at a regional tertiary care center in the United States.</a> American Journal of Perinatology. , (2021).</li><li>White, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laryngeal+mask+ventilation+during+neonatal+resuscitation:+A+case+series.">Laryngeal mask ventilation during neonatal resuscitation: A case series.</a> Children. 9 (6), 897 (2022).</li><li>Berry, A. M., Brimacombe, J. R., Verghese, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+laryngeal+mask+airway+in+emergency+medicine,+neonatal+resuscitation,+and+intensive+care+medicine.">The laryngeal mask airway in emergency medicine, neonatal resuscitation, and intensive care medicine.</a> International Anesthesiology Clinics. 36 (2), 91-109 (1998).</li><li>Wall, S. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neonatal+resuscitation+in+low-resource+settings:+what,+who,+and+how+to+overcome+challenges+to+scale+up.">Neonatal resuscitation in low-resource settings: what, who, and how to overcome challenges to scale up.</a> International Journal of Gynaecology and Obstetrics. 107 Suppl 1 (Suppl 1), S47-62-S63-44 (2009).</li><li>Hainstock, L. M., Raval, G. 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E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+characteristics+of+positive+pressure+ventilation+delivered+to+newborns+in+a+US+tertiary+academic+hospital.">Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.</a> Resuscitation. 115, 102-109 (2017).</li><li>Skare, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ventilation+fraction+during+the+first+30s+of+neonatal+resuscitation.">Ventilation fraction during the first 30s of neonatal resuscitation.</a> Resuscitation. 107, 25-30 (2016).</li><li>Bansal, S. C., Caoci, S., Dempsey, E., Trevisanuto, D., Roehr, C. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+laryngeal+mask+airway+and+its+use+in+neonatal+resuscitation:+A+critical+review+of+where+we+are+in+2017/2018.">The laryngeal mask airway and its use in neonatal resuscitation: A critical review of where we are in 2017/2018.</a> Neonatology. 113 (2), 152-161 (2018).</li><li>Qureshi, M. J., Kumar, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laryngeal+mask+airway+versus+bag-mask+ventilation+or+endotracheal+intubation+for+neonatal+resuscitation.">Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation.</a> The Cochrane Database of Systematic Reviews. 3 (3), CD03314 (2018).</li><li>Belkhatir, K., Scrivens, A., O'Shea, J. E., Roehr, C. 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E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neonatal+intubation+practice+and+outcomes:+an+international+registry+study.">Neonatal intubation practice and outcomes: an international registry study.</a> Pediatrics. 143 (1), e20180902 (2019).</li><li>Konrad, C., Schupfer, G., Wietlisbach, M., Gerber, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+manual+skills+in+anesthesiology:+Is+there+a+recommended+number+of+cases+for+anesthetic+procedures.">Learning manual skills in anesthesiology: Is there a recommended number of cases for anesthetic procedures.</a> Anesthesia and Analgesia. 86 (3), 635-639 (1998).</li><li>Pejovic, N. 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Training in newborn resuscitation can reduce term intrapartum-related deaths by 30%18. The Oklahoma Children&#39;s Hospital at University of Oklahoma (OU) Health, located on the campus of the University of Oklahoma Health Sciences Center in Oklahoma City, OK, requires all healthcare providers who assist in the management of newborns to maintain up-to-date NRP training. According to the current NRP guidelines, the most vital aspect of neonatal resuscitation is the effective delivery of positive pre...

Birth asphyxia accounts for ~1 million deaths each year and is a primary cause of early neonatal mortality1.&#160;In high-income countries, the incidence of perinatal asphyxia is ~1/1000 live births; it can be up to 10 times higher in low-middle-income countries1. Approximately 15%-20% of asphyxiated infants die in the first month of life and up to one-fourth of survivors sustain permanent neurologic deficits2,3. As reported by the Centers for Disease Control and Prevention, intrauterine hypoxia and birth asphyxia account for 10% of infant mortality4. In the United States, 10% of all newborns need assistance in the delivery room to breathe, with less than 1% needing more advanced resuscitative measures such as cardiac compressions and medications5. Interventions within the first minute of life have important long-term implications for outcomes6.
Effective ventilation using a face mask is often challenging for those who infrequently perform neonatal resuscitation. Resultant hypoxia, bradycardia, and emergent tracheal intubation increase unanticipated neonatal intensive care unit (NICU) admissions. The most common problems associated with a poor face mask technique include mask leakage, air blockage, and insufficient chest excursion7,8,9. NRP includes ventilation corrective steps, but mastery of these skills is difficult if not performed often.
The American Heart Association and American Academy of Pediatrics developed the Neonatal Resuscitation Program (NRP) to teach an evidence-based approach to newborn care. The NRP algorithm calls for tracheal intubation when face mask ventilation is ineffective or prolonged5. However, pediatric trainees have also shown difficulty performing intubation and have few opportunities to practice10,11,12. An SGA is an appropriate alternative airway in newborns weighing &#62;1500 g when face mask ventilation is insufficient and endotracheal intubation is unsuccessful or not feasible13,14,15,16. Although many studies support the feasibility and utility of SGA for initial respiratory management in low-middle-income countries, there is a paucity of data to support the use of SGA to perform initial PPV in high-income countries9,10,11.
We speculate that the mastery of SGA use has the potential to reduce PPV interruptions and therefore improve resuscitation outcomes. Our overarching objective was to evaluate the effectiveness of focused SGA training on newborn resuscitation outcomes, including PPV duration, ventilation failures, and complications.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>CO2 detector</td>
			<td>Medtronic USA</td>
			<td>42271500</td>
			<td>Nellcor pediatric colorimetric CO2 detector (pedicap)</td>
		</tr>
		<tr>
			<td>I-gel supraglottic airway</td>
			<td>Intersurgical</td>
			<td>8201000</td>
			<td>Neonatal size # 1</td>
		</tr>
		<tr>
			<td>Lubricant</td>
			<td>Laerdal Medical AS</td>
			<td>252090</td>
			<td>Airway Lubricant Spray Can (180 mL)</td>
		</tr>
		<tr>
			<td>Neonatal Patient Simulator&#160;</td>
			<td>Laerdal Medical AS</td>
			<td>296-00050</td>
			<td>SimNewB Light tetherless</td>
		</tr>
		<tr>
			<td>Positive pressure ventilation device</td>
			<td>Fisher &#38; Paykel Healthcare</td>
			<td>RD900</td>
			<td>Neopuff Infant T-Piece Resuscitator</td>
		</tr>
	</tbody>
</table>

laryngeal mask airway (lma) placement in a neonatal patient simulator using a non-inflatable supraglottic airway (sga)

The effective delivery of positive pressure ventilation (PPV) can be challenging during neonatal resuscitation. Achieving a patent airway through an appropriate interface during neonatal resuscitation is critical for avoiding airway obstruction and leakage and optimizing access to PPV. Due to the complexity of face mask ventilation, providers have explored corrective steps. However, these methods are difficult to master and thus may present a risk for ventilation delay and/or interruptions at the critical time of resuscitation and the development of complications. In addition, neonatal endotracheal intubation is an invasive procedure that requires significant practice and training. The supraglottic airway (SGA) is a useful laryngeal mask airway (LMA) interface that decreases the time required to achieve a secure airway and reduces the need for endotracheal intubation. Despite the available evidence regarding its effectiveness, insufficient training and awareness limit SGA use in the real world, and frontline providers report low confidence in SGA placement. Here we provide a detailed description of SGA placement, the instruction of which requires only minimal training and leads to a short time to proficiency. Briefly, after the administration of initial ventilatory corrective steps in a neonatal manikin, a provider inserts a non-inflatable SGA into the larynx. This method allows for a single individual to provide effective delivery of PPV in a noninvasive manner without the need for expensive equipment such as video laryngoscopy. Instructors can easily teach this technique with ease and little cost in any clinical and research setting. This is also true for different income settings, including high-, middle-, and low-income countries.

Following successful SGA placement, effective PPV can be confirmed by listening for air entry bilaterally in the lungs and visualizing chest wall movement with ventilation (Figure 1). Occasionally, an incorrect position can result in ineffective lung aeration, resulting in failure to raise heart rate, improvements in oxygen saturation, and a color change to yellow on the CO2 colorimeter.
A recent case series17 at our institution&...

Watch this Scientific Journal Video about Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA at JoVE.com

Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA

This protocol is designed to describe a method to place and establish a supraglottic (alternative) airway during neonatal resuscitation. It can be used in situations where frontline providers cannot ventilate or endotracheally intubate neonates requiring resuscitation.

Laryngeal Mask Airway (LMA) Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway (SGA)

The effective delivery of positive pressure ventilation (PPV) can be challenging during neonatal resuscitation. Achieving a patent airway through an ...

This method can help answer key questions in the field of newborn resuscitation, which bridges the transition from fetal to neonatal life. The main advantage of this technique is that it can be used in challenging situations where frontline providers cannot ventilate or endotracheally intubate neonates requiring resuscitation. The implications of this technique extend toward the therapy of respiratory distress syndrome.This method could provide insight into birth asphyxia or hypoxic ischemic encephalopathy. To begin, select an appropriate size supraglottic airway, or SGA. Open the SGA and remove the pack that holds the device.Then open the pack and transfer the SGA to the lid of the pack. Next, holding the integral bite block, apply a thin coat of lubricant to the back, sides, and front of the SGA, avoiding contact with the cuff of the device. Carefully check the device for foreign bodies or a bolus of lubricant obstructing the distal opening and return the SGA to the cage pack.Next, decompress the stomach with an orogastric tube. Remove the SGA from the container and hold the lubricated SGA firmly. Now stand at the baby's head and position the device with the cuff outlet facing the chin of the baby.After ensuring the baby is in the sniffing position with the head extended and neck flexed, gently open the mouth and press down the chin before proceeding. Then press the leading soft tip into the mouth against the baby's hard palate on top of the tongue, maintaining pressure against the palate. Gently slide the device inward following the contour of the mouth and palate until resistance is felt.Position the tip of the airway into the upper esophagus, aligning the cuff against the laryngeal framework. Next, to confirm the correct placement of the laryngeal mask, connect the carbon dioxide detector to the PPV device. After correct placement, ensure bilateral chest movement during ventilation and listen for equal breath sounds.Using tape, secure the SGA down from maxilla to maxilla. To remove the laryngeal mask, use bulb suction or suction catheter to remove secretions from the mouth and throat. Then remove the SGA device and monitor heart rate, breathing, and oxygen saturation.In the cohort of newborns receiving SGA intervention, initial insertion was successful and provided immediate stabilization in all cases with avoidance of NICU admission noted in 38%of cases when used at birth. It's important to work with a trained team with assigned roles to ensure that all tasks are completed consistently. Practice regularly for laryngeal mask placement.Once mastered, laryngeal mask placement can be completed in 10 seconds. After achieving a supraglottic airway, timely and effective delivery of positive pressure ventilation, continuous positive airway pressure, supplemental oxygen, and/or surfactant administration can be performed to facilitate lung aeration. This technique improved the training and performance of ventilation among skilled frontline providers in a depressed newborn baby at the critical time of birth.Studies on this technique will optimize the delivery of newborn resuscitative care.

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