Abstract
Objective In 2015, Neonatal Resuscitation Program (NRP) recommended laryngeal mask airway (LMA)
as an alternative to the endotracheal tube (ETT) in situations where the provider
is “unable to intubate and unable to ventilate.” LMA insertion is being taught in
the NRP routinely. However, endotracheal intubation is the primary method considered
as the standard of care in neonatal resuscitation. LMA insertion is a relatively simple
procedure with an average insertion time of < 10 seconds. Newer generation LMA can
have the added advantage of reducing the risk of aerosol generation and improving
the safety of the providers. Only a few recent studies have evaluated the LMA insertion
skills of neonatal resuscitation providers. We wanted to study the proficiency of
NRP providers in the technique of LMA insertion. We hypothesized that NRP providers
would have LMA insertion skills equivalent to the standard of care (ETT insertion).
Study Design A manikin-based study was done from July 2019 to December 2019. We enrolled 31 NRP
providers with 1 or more years since the first certification and current valid NRP
provider/instructor status. The participants were instructed to insert an ETT and
LMA in the manikin. The procedures were video recorded. The time taken to insert and
start ventilation with each device, including the number of attempts for successful
insertion, was noted. A Likert scale questionnaire was filled by each participant
indicating the level of confidence, perception of ease, and the ability to provide
effective positive pressure ventilation (PPV) with each of the procedures. The paired
t-test, chi-square test, and Kruskal–Wallis' test were used for the statistical analysis.
Results Eight (25.8%) out of the 31 participants failed to insert any one of the devices.
So, 23 providers were analyzed for the outcomes. We found that the mean duration taken
to insert the ETT and LMA was not statistically different (32 vs. 36 seconds). LMA
insertion had a higher failure rate compared with ETT. Providers did not perceive
confidence to insert LMA when compared with ETT. They did not recognize LMA insertion
as a more effortless procedure relative to endotracheal intubation. The providers
felt that their ability to provide effective PPV using LMA was inferior to ETT.
Conclusion The NRP certified providers in this study did not demonstrate proficiency in the
insertion of LMA equivalent to the endotracheal intubation.
Key Points
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LMA insertion skill was studied in NRP providers using a manikin.
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Providers had a higher frequency of failure in inserting LMA compared to ETT.
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Providers' perceived confidence and effectiveness of the LMA procedure were inferior
to ETT.
Keywords
laryngeal mask airway - infant, newborn - resuscitation - manikin - intubation, intratracheal
