Providing effective positive pressure ventilation is the single most important component of successful neonatal resuscitation. Ventilation is frequently initiated with a manual resuscitation bag and face-mask (BMV) followed by endotracheal intubation (ETT) if depression continues. These techniques may be difficult to perform successfully resulting in prolonged resuscitation or severe neonatal depression. The laryngeal mask airway (LMA) may achieve initial ventilation and successful resuscitation faster than a bag-mask device or endotracheal intubation.
Among newborns requiring positive pressure ventilation for resuscitation, is effective ventilation and successful resuscitation achieved faster with the LMA compared with either BMV or ETT?
The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), MEDLINE (1966-November 2004), Pre-MEDLINE (November 15, 2004), CINAHL 1982-November 2004), reference lists of published trials, and Society for Pediatric Research abstracts were searched. Experts were contacted for additional references.
Randomised and quasi-randomised trials
Two reviewers independently evaluated studies, assessed methodologic quality, and extracted data using the Cochrane Neonatal Review Group criteria. Categorical treatment effects were described as relative risks and risk differences and continuous treatment effects were described as the mean difference. There were insufficient data to perform pooled analyses.
No eligible studies compared the LMA with BMV. One small randomised controlled trial comparing the LMA with ETT when BMV had been unsuccessful was included. There was no statistically significant difference between the LMA and ETT with the exception of a clinically insignificant difference in time to complete insertion of the device favouring the ETT.
The LMA is a small mask with an inflatable cuff attached to a silicone rubber airway tube. It is inserted orally using the operator's index finger and guided along the hard palate without laryngoscopy or other instruments. When the device is fully inserted, the mask lumen sits over the laryngeal opening while the cuff conforms to the contours of the hypopharynx occluding the esophagus with a low-pressure seal. After inflating the cuff, the LMA can be used to control the airway of spontaneously breathing patients or to provide positive pressure ventilation. Since its introduction, the LMA has been used for both adult and pediatric anaesthesia and is the initial adjunctive airway device recommended by the American Society of Anaesthesiologists' difficult airway algorithm (Benumof 1996). The potential advantages of using a LMA for neonatal resuscitation include the ease of insertion without laryngoscopy and minimal instrumentation of the larynx. Potential disadvantages include gastric distention, inadequate alveolar ventilation, and possible difficulty suctioning the airway or administering emergency intra-tracheal medications.
The most recent statements from the Pediatric Working Group of the International Liaison Committee on Resuscitation (ILCOR), the American Academy of Pediatrics Neonatal Resuscitation Program Steering Committee, and the American Heart Association Emergency Cardiovascular Care Pediatric Resuscitation Subcommittee of the Emergency have recommended considering the LMA for airway control when both BMV and ETT have been unsuccessful (Kattwinkel 1999; Niermeyer 2000). These organizations did not recommend routinely using the LMA instead of either (i) BMV as the primary airway device or (ii) ETT as the secondary device because of insufficient evidence documenting safety and efficacy at the time of their review. Given that establishing ventilation is the most critical aspect of successful neonatal resuscitation, it is important to answer each of the following two questions: (1) Does the LMA achieve initial ventilation and successful resuscitation faster than a bag-mask device, and (2) When bag-mask ventilation is either insufficient or ineffective, does the LMA achieve effective ventilation and successful resuscitation faster than endotracheal intubation.
Planned Subgroup analyses:
Randomised and quasi-randomised controlled studies were included. Studies describing LMA placement in the operating room for airway control during anaesthesia and those describing the LMA for airway control during diagnostic bronchoscopy were excluded.
(1) Term or preterm infants who required positive pressure ventilation
for cardiopulmonary resuscitation due to any cause during the first 28 days
of life.
(2) Term or preterm infants who required positive pressure ventilation
for cardiopulmonary resuscitation due to any cause during the first 28 days
of life, where bag-mask ventilation was found to be either insufficient or
ineffective.
(1) LMA used for initiating positive pressure ventilation, with any insertion
technique, for neonatal cardiopulmonary resuscitation compared with bag-mask
ventilation.
(2) LMA used as a secondary airway device, with any insertion technique,
for neonatal cardiopulmonary resuscitation, when bag-mask ventilation was
found to be insufficient or ineffective, compared with endotracheal intubation.
Primary outcome measures:
1. Time (seconds) from birth, or from beginning of intervention, until heart rate greater than 100 beats/minute.
2. Time (seconds) from birth, or from beginning of intervention, required to correctly insert the device
3. Number of attempts to complete procedure.
Secondary outcome measures:
1. Time (seconds) from birth, or from beginning of intervention, to achieve effective chest expansion
2. Time (seconds) from birth, or from beginning of intervention, to pink skin color
3. Number of times endotracheal intubation required (LMA vs. BMV studies only)
4. Objective ratings (any scale) of operator satisfaction
5. Apgar score < 7 at five minutes (delivery room resuscitation studies
only). This outcome measure was added after the initial review of potentially
eligible studies.
6. Frequency of procedure failures
7. Frequency of pneumothorax
8. Frequency of epinephrine administration
9. Frequency of device malposition and/or dislodgement
10. Frequency of post-resuscitation oral, airway, or facial trauma; stridor; suspected aspiration; or vocal cord paralysis
11. Frequency of device failure (e.g. cuff leak, tube crack)
The standard search method of the Cochrane Neonatal Review Group (CNRG) described in the Cochrane Library and CNRG Guidelines was used.
1. Published articles: Eligible trials were identified from MEDLINE (OVID and PubMed, 1966 - November, 2004), Pre-MEDLINE (November 15, 2004), CINAHL (1982 - November, 2004), and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004). We used the following search strategy: (exp Laryngeal Mask (MeSH) or laryngeal mask$.mp) or LMA.tw., limited (MEDLINE, Pre-MEDLINE, and CINAHL) to all infant (birth to 1 year). Pre-MEDLINE and CENTRAL were also searched using the terms (exp Laryngeal Masks (MeSH) or laryngeal mask$.mp or LMA.tw. and exp Resuscitation (MeSH). The search was not limited by either language or publication type in order to maximize search sensitivity. The bibliographies of retrieved articles were reviewed for additional references. Two members [Dr. Udaeta (Mexico) and Dr. Carlo (USA)] of the Neonatal Task force of the International Liaison Committee on Resuscitation were contacted to identify additional references. Esmail 2002 was not identified using our electronic or hand-search strategy but was brought to our attention by Dr. Udaeta. We were able to locate the full-text of this study on-line (www.google.com, last accessed July 7, 2004)) with the search terms "LMA and neonate".
2. Published abstracts: Abstracts of the Society for Pediatric Research (USA) published in Pediatric Research (1993 - 2004) were hand-searched using the key words: laryngeal mask and resuscitation.
3. Unpublished trials: After completing the initial review of retrieved articles, we attempted to contact authors that commented on pending trials, authors of included studies, and three authors of case series that did not meet inclusion criteria (Brimacombe, J; Paterson, S; Trevisunato, D) to identify unpublished or pending trials. We successfully contacted Drs. Brimacombe and Trevisunato; no unpublished or pending trials were identified.
The standard methods of the Cochrane Collaboration and the Neonatal Review Group were used as described in the Cochrane Collaboration Handbook. Two reviewers independently evaluated and scored potentially relevant studies for inclusion and methodologic quality. The assessment of methodologic quality was based on a review of the opportunity for bias in accordance with the standard methods of the Neonatal Review Group. Studies were scored for blinding of randomisation, blinding of the intervention, completeness of follow-up, and blinding of outcome measurements. Two investigators independently extracted and coded all data from included trials using a standardized form. To the extent possible, outcome data were extracted on all randomised patients. We attempted, unsuccessfully, to contact one investigator (Esmail 2002) for additional outcome measurements and clarification regarding the methods of randomisation and blinding. Data were entered into RevMan by a single investigator and checked for accuracy by a second investigator. There were no disagreements regarding the assessment of trials for inclusion, assessment of methodologic quality, or data extraction.
Data were analysed using the standard statistical methods of the Cochrane Neonatal Review Group. Categorical treatment effects are described as relative risks, risk differences, and the number needed to treat with 95% confidence intervals. Continuous treatment effects are described as the mean difference with 95% confidence intervals. There were insufficient data to performed pooled analyses. A fixed effect model was assumed and we would have used the heterogeneity (I2 ) statistic to help decide on pooling.
Five potentially eligible studies were identified. One study (Esmail 2002) met the inclusion criteria. Esmail 2002 compared the size-1 LMA vs. ETT among newborns at a single center (Cairo University, Egypt, 1999-2000) requiring resuscitation in the delivery room. In each treatment group, the enrolled subjects were similar with respect to birth weight and gestational age. The mean birthweight (SD) was 3369 (655) grams in the LMA group and 3450 (565) grams in the ETT group. The authors do not describe how or when randomisation was performed. It is unclear how many potentially eligible subjects were excluded or if any randomised subjects were excluded after randomisation. The number of placement attempts made with each device, elapsed time, skin color, heart rate, spontaneous respiratory rate, and Apgar score (1, 5, 10 minutes) were recorded. The individual completing this assessment was not blinded to treatment allocation. The authors did not provide details describing who made these outcome assessments. A fibreoptic laryngoscope was used to ascertain the position of the LMA and to evaluate for soft tissue trauma. In the ETT group, it is not clear how the position of the ETT and soft tissue trauma were assessed. It is not clear when these placement and trauma assessments were made. The resuscitators' level of training and professional credentials were not described.
Four non-randomised, single-center, observational studies were excluded from this review (Paterson 1994; Gandini 1999; Trevisanuto 2004a; Zanardo 2004). Two of the excluded studies (Paterson 1994; Gandini 1999) were prospective case-series describing delivery room resuscitation using a LMA without a comparison group. One study (Trevisanuto 2004a) was a retrospectively assembled LMA case-series compared with both a historical and a concurrent group of newborns resuscitated using a bag-mask device. The allocation to LMA or BMV was at the resuscitator's discretion without randomisation. The fourth study (Zanardo 2004) was a retrospectively assembled cohort study designed to assess the rate of neonatal depression after elective cesarean section delivery compared with vaginal delivery. The authors included a sub-analysis in which resuscitations using the LMA were compared to those using an ETT following either cesarean section or vaginal delivery. In this study, the decision to use a LMA or ETT was left to the resuscitator's discretion without randomisation. It appears that some of the newborns reported in Trevisanuto 2004a are reported again in Zanardo 2004.
Fifteen case reports describing 15 neonates resuscitated using the LMA were excluded from this review because they were not randomised trials (Baker 2004; Baraka 1995; Brimacombe 1995a; Brimacombe 1999; Brimacombe 2004; Bucx 2003; Denny 1990; Fernandez-Jur 2002; Fraser 1999; Fraser 1999b; Gandini 2003; Mawer 1995; Nagahama 1995; Trawoger 1999; Yao 2004). Several of these reports described newborns with cranio-facial anomalies that required resuscitation and could not be ventilated with BMV or intubated with an ETT. In these cases, the LMA provided a rescue airway. A survey of current practice in a single region of Italy was excluded because it was not a randomised trial (Trevisanuto 2004b). This survey described 101 newborns resuscitated in the delivery room using a LMA. These subjects were included in two other reports by the same authors (Trevisanuto 2004a; Zanardo 2004).
In the study by Esmail 2002, the methods, timing, and concealment of randomisation were not stated. The intervention was not blinded. Outcome data were provided for all 40 of the described subjects, however, it is unclear if there were any randomised subjects that were excluded post-randomisation because of the need for chest compressions or the identification of a congential anomaly. In addition, the duration of follow-up was not clear. The individual(s) measuring outcomes during the intervention (number of attempts, Apgars, heart rate) did not appear to be masked to treatment allocation. The individual(s) performing fibreoptic assessments of LMA position and soft-tissue trauma were not masked to treatment allocation.
No eligible studies were identified comparing the LMA with BMV. One study (Esmail 2002) comparing the LMA to ETT during neonatal resuscitation contributed data for this review.
Laryngeal Mask Airway (LMA) vs. Bag-mask ventilation (BMV)
No eligible studies identified.
Laryngeal Mask Airway (LMA) vs. Endotracheal Intubation (ETT)
Primary Outcomes:
1. Time (seconds) until heart rate greater than 100 beats/minute: Esmail 2002 graphically reported the average heart rate ± SD for both groups at 10 second intervals (0-90 seconds). The average heart rate improved over the first 90 seconds in both groups and the authors stated that there was no statistically significant difference between the groups at any point.
2. Time (seconds) required to correctly insert the device: There was a statistically significant increase in the time required to correctly insert the LMA compared with the ETT [mean difference 2.50 seconds (1.27-3.73)]. This is not likely to be a clinically important difference. No subject required cross-over to the alternate device. Overall, the time required to insert both devices [mean (SD) seconds] was very short [LMA 10 (2.5), ETT 7.5 (1.3)].
3. Failure to correctly insert the device after one attempt: There was no statistically significant difference in the LMA group compared with the ETT group [RR 1.50 (0.28, 8.04), RD 0.05 (-0.15-0.25)]. The resuscitators had a very high first time success rate with both devices (LMA 17/20, ETT 18/20). No subject required cross-over to the alternate device.
4. Duration (seconds) of resuscitation: Not reported
5. Death in the delivery room: There were no delivery room deaths in either group.
6. Death, all causes, before hospital discharge: No deaths were reported, however, the duration of follow-up is not reported.
Secondary Outcomes:
1. Time (seconds) to achieve effective chest expansion: Not reported
2. Time (seconds) to pink skin color: Esmail 2002 graphically reported the number of subjects with uniform pink and uniform cyanotic skin color at 10 second intervals (0-90 seconds). The skin color improved over the first 90 seconds in both groups and the authors stated that there was no statistically significant difference between the groups at any point.
3. Number of times endotracheal intubation required (LMA vs. BMV studies only): Not applicable.
4. Objective ratings (any scale) of operator satisfaction: Not reported
5. Apgar score < 7 at 5 minutes: None reported in either group.
6. Frequency of procedure failures: None reported in either group.
7. Frequency of pneumothorax: None reported in either group.
8. Frequency of epinephrine administration: No subject received epinephrine in either group.
9. Frequency of device malposition and/or dislodgement: Not reported
10. Frequency of post-resuscitation oral, airway, or facial trauma; stridor; suspected aspiration; or vocal cord paralysis: There was no statistically significant difference in soft tissue trauma (epiglottis, uvula, tongue) between the LMA and the ETT treated groups [RR 2.00 (0.58, 6.91), RD 0.15 (-0.10, 0.40)]. It is unclear when this outcome was ascertained.
11. Frequency of device failure (e.g. cuff leak, tube crack): None reported in either group.
Methodologic problems limit both the validity and applicability of the only study included in this review. Esmail 2002 was subject to bias in enrollment, allocation, and outcome measurement. The authors did not provide important details about the recruitment or randomisation process. Although the study enrolled newborns who had failed to respond to bag-mask ventilation, none of the subjects were severely depressed and they may not have been representative of the population of neonates requiring prolonged resuscitation in the delivery room. Infants requiring chest compressions were excluded from enrollment. If the LMA achieves effective ventilation quickly, it may decrease the number of newborns that ultimately require chest compressions (Perlman 1995). It will be important, however, to establish whether the LMA can be used during chest compressions before recommending this device as either the primary airway or the first-choice secondary airway. Although the investigators found a statistically shorter time for ETT placement compared with LMA placement, this finding may not be generalizable to other settings. All of the resuscitators in this study appeared to have been anaesthesiologists. They had substantially higher rates of success and completed ETT in shorter times than those reported for pediatrician-directed resuscitations. Carbine 2000 found that neonatal resuscitation teams consisting of either a staff neonatologist, neonatal fellow, neonatal nurse practitioner, or senior pediatric resident successfully placed an ETT during the first attempt in only 7/12 newborns and only 4/12 were intubated in < 20 seconds. Similarly, Falck 2003 reported that only 50-62% of neonatal intubation procedures were successful on the first or second attempt by pediatric residents. A total of 35% of neonates were never successfully intubated by a pediatric resident after a maximum of 4 attempts. The higher than expected rate of success for the control (ETT) treatment may have limited the investigators' ability to identify a difference between groups. Finally, it is unclear if the investigators assessing outcomes were blinded to treatment allocation, when certain outcomes (LMA position, trauma) were actually ascertained, and how long subjects were followed. Overall, Esmail 2002 found no clinically significant difference between the LMA and ETT, among skilled operators, if attempts with a bag-mask device were unsuccessful. This study did not address the use of the LMA as an alternative to BMV for initial ventilation; however, all of the infants in the LMA group were successfully resuscitated using the LMA and had previously failed to respond to BMV.
We were unable to identify any randomised trials directly comparing the LMA with BMV for initial positive pressure ventilation. At the present time, the best available evidence evaluating the safety and efficacy of the LMA for initial ventilation comes from three non-randomised observational studies. Paterson 1994, Gandini 1999, and Trevisanuto 2004a reported case series including a total of 220 newborns treated at three centers. Paterson 1994 reported the first prospective series using the LMA in place of BMV in the delivery room for term and near-term newborns. The study team resuscitated 21 newborns (weight range 2235-4460 grams) and successfully inserted the LMA during the first attempt in all 21 newborns. The heart rate exceeded 100 bpm within 30 seconds in 20/21 patients. One newborn failed to respond to both LMA insertion and subsequent endotracheal intubation. The time [mean ± SD, (range)] required for LMA placement in the remaining 20 subjects was 8.6 ± 1.4 seconds (7-12). Gandini 1999 subsequently reported the largest delivery room series. In contrast to Paterson 1994 and Esmail 2002, Gandini 1999 included newborns without specified weight or gestational age limits. The subjects included 29 "low birth weight" newborns with six newborns < 1500 grams. The smallest subject was 1000 grams. The LMA was inserted successfully during the first attempt in all 104 newborns and effective ventilation was achieved in 103/104. Adequate chest expansion was achieved by 10 seconds (mean) in both normal and low birth-weight newborns. One subject, without apparent meconium staining, did not improve with either the LMA or an ETT and was found to have severe meconium aspiration at postmortem examination. Finally, Trevisanuto 2004a retrospectively compared all neonatal resuscitations at a single center during two different years. The LMA was not used at all in 1996, but was used at the physician's discretion during 25% of near-term (> 34 weeks, > 2000 grams) deliveries in 2000. Trevisanuto 2004A then compared all newborns resuscitated with the LMA in 2000 with a gestational age matched group resuscitated in the same year with BMV. The LMA was "easily inserted" and provided "effective ventilation" in 94/95 neonates during resuscitation. The infant that did not respond was ultimately intubated with an ETT and was found to have a tension pneumothorax. In the gestational age matched BMV comparison group, there were four newborns that did not respond to BMV and were successfully treated with the LMA. Two of these newborns had micrognathia. In ten additional case reports, the LMA was used as a life-saving rescue airway for neonates when both BMV and ETT were unsuccessful (Baker 2004; Baraka 1995; Brimacombe 1995a; Brimacombe 1999; Brimacombe 2004; Bucx 2003; Denny 1990; Fraser 1999; Gandini 2003; Mawer 1995; Trawoger 1999).
There is no evidence from controlled trials to evaluate the relative efficacy and safety of the laryngeal mask airway (LMA) compared with bag-valve-mask ventilation (BMV) as the primary airway device during neonatal resuscitation. A single, small randomised controlled trial found no clinically significant difference between the LMA and ETT as a secondary airway device when BMV was unsuccessful. Methodologic problems with this single study, however, limit both the interpretation and applicability of the results. There is insufficient evidence to evaluate the LMA in the setting of meconium-stained amniotic fluid, chest compressions, or for the delivery of emergency intra-tracheal medications.
The best available evidence comes from observational studies, and suggests that the LMA can provide a rescue airway and achieve effective positive pressure ventilation during resuscitation of the newborn infant if both BMV and ETT have been unsuccessful. Although the evidence supporting this conclusion is largely extrapolative and based on case reports, the non-invasive nature of LMA placement in comparison with the alternative (tracheostomy), and the practical difficulties of designing a randomised controlled trial in this unpredictable emergency situation make it unlikely that definitive evidence will become available.
Randomised controlled trials comparing the LMA with BMV as the primary airway device during neonatal resuscitation are warranted. Additional randomised controlled trials are warranted comparing the LMA with ETT during neonatal resuscitation when BMV has been unsuccessful. These trials should include both term and preterm newborns requiring positive pressure ventilation, chest compressions, and emergency intratracheal medications. Trials comparing neonatal "manikin only" training with "live-patient" training are indicated to further evaluate the training requirements for neonatal resuscitators.
| Study | Methods | Participants | Interventions | Outcomes | Notes | Allocation concealment |
| Esmail 2002 | Blinding of randomization: Can't tell, the randomization method is not described. Blinding of intervention: No. Complete follow-up: Yes, for the 40 described subjects, but it is unclear if there were any post-randomisation exclusions and the duration of follow-up is not described. Blinding of outcome measurement: Can't tell, not described. The laryngoscopic assessment of LMA position could not have been blinded. | Single center study (Cairo University Hospital, Egypt, 1999-2000). Newborns with expected gestation >/= 35 weeks and expected weight >/= 2.5 kg following Cesarean section delivery with Apgar 0-3 after one minute of positive pressure ventilation using a bag-mask device. Newborns with congenital anomalies and those requiring chest compressions were excluded. Unknown how many potentially eligible subjects were not enrolled. | Size-1 LMA (n=20) or ETT (n=20). For LMA, positive pressure ventilation using a Jackson-Rees modification of an Ayres T-piece circuit with a pressure manometer to a maximum of 20 cm H2O pressure. Allowed 3 LMA attempts, then cross-over to ETT. For ETT, two attempts within 40 seconds were allowed, then cross-over to LMA. | Time required to place device; time of positive pressure ventilation; skin color, heart rate, spontaneous respiratory effort, breath sounds (measured at 10 second intervals starting a beginning of insertion attempt); Apgar score at 1, 5, 10 minutes; pulse oximetry (measured every minute until resuscitation completed); "response to resuscitation and airway patency" (15-30 second intervals); LMA position and soft tissue trauma (epiglottis, tongue, uvula) using a fiberoptic laryngoscope (not stated when this assessment took place). | B |
| Study | Reason for exclusion |
| Baker 2004 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Baraka 1995 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Brimacombe 1995a | Not a randomized or quasi-randomized trial. A single patient case report. |
| Brimacombe 1999 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Brimacombe 2004 | Not a randomized or quasi-randomized trial. A case report describing 2 newborns, 1 requiring resuscitation. |
| Bucx 2003 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Denny 1990 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Fernandez-Jur 2002 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Fraser 1999 | Not a randomized or quasi-randomized trial. A case report describing 2 neonates requiring resuscitation. |
| Fraser 1999b | Not a randomized or quasi-randomized trial. Additional information about one patient described in Fraser 1999. |
| Gandini 1999 | Not a randomized or quasi-randomized trial. Prospective case-series without a comparison group. |
| Gandini 2003 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Mawer 1995 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Nagahama 1995 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Paterson 1994 | Not a randomized or quasi-randomized trial. Prospective case-series without a comparison group. |
| Trawoger 1999 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Trevisanuto 2004a | Not a randomized or quasi-randomized trial. Retrospective case-series with historical and concurrent, non-randomized comparison groups. |
| Trevisanuto 2004b | Not a randomized or quasi-randomized trial. A survey of anesthesiologists and pediatricians. |
| Yao 2004 | Not a randomized or quasi-randomized trial. A single patient case report. |
| Zanardo 2004 | Not a randomized or quasi-randomized trial. Retrospective cohort study with a non-randomized comparison group. |
Esmail N, Saleh M, Ali A. Laryngeal mask airway versus endotracheal intubation for Apgar score improvement in neonatal resuscitation. Egyptian Journal of Anesthesiology 2002;18:115-21.
Baker PA, Aftimos S, Anderson BJ. Airway management during an EXIT procedure for a fetus with dysgnathia complex. Paediatric Anaesthesia 2004;14:781-6.
Baraka 1995 {published data only}
Baraka A. Laryngeal mask airway for resuscitation of a newborn with Pierre-Robin syndrome. Anesthesiology 1995;83:645-6.
Brimacombe 1995a {published data only}
Brimacombe JR, De Maio B. Emergency use of the laryngeal mask airway during helicopter transfer of a neonate.[see comment]. Journal of Clinical Anesthesia 1995;7:689-90.
Brimacombe 1999 {published data only}
Brimacombe J, Gandini D. Airway rescue and drug delivery in an 800 g neonate with the laryngeal mask airway. Paediatric Anaesthesia 1999;9:178.
Brimacombe 2004 {published data only}
Brimacombe J, Gandini D, Keller C. The laryngeal mask airway for administration of surfactant in two neonates with respiratory distress syndrome. Paediatric Anaesthesia 2004;14:188-90.
Bucx 2003 {published data only}
Bucx MJ, Grolman W, Kruisinga FH, Lindeboom JA, Van Kempen AA. The prolonged use of the laryngeal mask airway in a neonate with airway obstruction and Treacher Collins syndrome. Paediatric Anaesthesia 2003;13:530-3.
Denny 1990 {published data only}
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Fernandez-Jur 2002 {published data only}
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Fraser 1999 {published data only}
Fraser J, Hill C, McDonald D, Jones C, Petros A. The use of the laryngeal mask airway for inter-hospital transport of infants with type 3 laryngotracheo-oesophageal clefts. Intensive Care Medicine 1999;25:714-6.
Fraser 1999b {published data only}
Fraser J, Petros A. High-frequency oscillation via a laryngeal mask airway. Anaesthesia 1999;54:404.
Gandini 1999 {published data only}
Gandini D, Brimacombe JR. Neonatal resuscitation with the laryngeal mask airway in normal and low birth weight infants. Anesthesia and Analgesia 1999;89:642-3.
Gandini 2003 {published data only}
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Mawer 1995 {published data only}
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Nagahama 1995 {published data only}
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Paterson 1994 {published data only}
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Trawoger 1999 {published data only}
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Trevisanuto 2004a {published data only}
Trevisanuto D, Micaglio M, Pitton M, Magarotto M, Piva D, Zanardo V. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004;62:151-7.
Trevisanuto 2004b {published data only}
Trevisanuto D, Ferrarese P, Zanardo V, Chiandetti L. Laryngeal mask airway in neonatal resuscitation: a survey of current practice and perceived role by anaesthesiologists and paediatricians. Resuscitation 2004;60:291-6.
Yao 2004 {published data only}
Yao C, Wang J, Tai Y, Tsai T, Wu J. Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway. Resuscitation 2004;61:97-99.
Zanardo 2004 {published data only}
Zanardo V, Simbi AK, Savio V, Micaglio M, Trevisanuto D. Neonatal resuscitation by laryngeal mask airway after elective cesarean section. Fetal Diagnosis and Therapy 2004;19:228-31.
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| Comparison or outcome | Studies | Participants | Statistical method | Effect size |
|---|---|---|---|---|
| 01 Laryngeal mask airway versus endotracheal intubation | ||||
| 01 Time to complete procedure (seconds) | 1 | 40 | WMD (fixed), 95% CI | 2.50 [1.27, 3.73] |
| 02 Failure to correctly insert the device after one attempt | 1 | 40 | RR (fixed), 95% CI | 1.50 [0.28, 8.04] |
| 03 Soft tissue trauma after device inserted | 1 | 40 | RR (fixed), 95% CI | 2.00 [0.58, 6.91] |
| The review is published as a Cochrane review in The
Cochrane Library, Issue 2, 2005 (see http://www.thecochranelibrary.com for
information). Cochrane reviews are regularly updated as new evidence emerges
and in response to comments and criticisms, and The Cochrane Library should
be consulted for the most recent version of the Review. |