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

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.