Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation

Using a laryngeal mask, a face mask or a tube directly into the large breathing passage (endotracheal intubation) for resuscitation of a newborn infants. Most newborns are vigorous at birth, but a small number need to be helped with breathing (assisted ventilation) in the delivery room. If infants do not have effective breathing soon after birth, they can
become severely depressed, so rapidly providing effective ventilation in the delivery room is very important. Ventilation is often started using a bag with oxygen attached, that is manually pumped (manual resuscitation bag) to force air into a close-fitting face mask held over the infant's nose and mouth. If breathing remains depressed after using the manual resuscitation bag, a tube is placed directly into the infant's large airway (endotracheal intubation). Bag and mask ventilation and endotracheal intubation may not be possible when infants have airway obstructions or head and face abnormalities, obstructing the normal flow of air through the nose and mouth into the lungs and obstructing the view of the airway by the medical personnel attempting intubation. The laryngeal mask airway is an alternative to bag and mask ventilation and endotracheal intubation that uses a small mask attached to the end of a silicone tube, which can be fitted into the throat to provide positive pressure ventilation into the airway. The review authors made a thorough search of the medical literature and found one, small randomized trial (with 40 infants) that compared the laryngeal mask with endotracheal intubation, when bag and mask ventilation had been unsuccessful. There was no clinical difference between the two methods. Overall, the time taken to insert both devices was very short (7.5 to 10 sec) and the resuscitators had a very high first time success rate. No eligible randomized studies compared the laryngeal mask with bag and mask ventilation.