LMA GRADE CoSTR
CONSENSUS ON SCIENCE:
LMA compared to FM as a primary device for infants at term requiring positive
pressure ventilation for resuscitation (3 RCT with 469 patients)
For the critical outcome of “achieving vital signs” we have identified low quality
evidence from 2 small RCTs and 1 large Quasi RCT, showing that LMA was more
effective than the FM (OR 11.43 95% CI 4.01- 32.58). For the critical outcome of “need
for subsequent endotracheal intubation after failed LMA or FM”, we have identified low
quality evidence from the same RCTs, showing that LMA was more effective than the FM
(OR 0.13 95% CI 0.05-34). For the critical outcome of ”Apgar score increasing” we have
identified low quality evidence from the same RCTs, not being possible to analyze these
outcome for the way of report in each study. For the critical outcome of “dead” we have
identified low quality evidence from the same RCTs, showing no difference between
LMA or FM. For the important outcome of “morbidity” we have identified low quality
evidence from the same RCTs, showing no difference for any variable between LMA or
FM (OR 5.76 95% IC 0.7 – 47.32). We did not identify any evidence to address the
critical outcomes of “indicators of brain injury” or “long term outcomes”.
LMA compared to ETT as a secondary device for infants at term requiring positive
pressure ventilation for resuscitation (1 RCT with 40 patients)
For the critical outcome of “achieving vital signs or successful resuscitation”, we have
identified very low quality evidence from one RCT showing that LMA was as effective as
the ETT tube. For the critical outcome of “need for subsequent endotracheal intubation
after failed LMA”, we have identified very low quality evidence from the same RCT
showing that LMA was as effective as ETT. For the critical outcome of “Apgar score
increasing” we have identified very low quality evidence from the same RCT, not being
possible to analyze these outcome for the presentation of the results in the study. For
the critical outcome of “dead” we have identified very low quality evidence from the
same RCT, showing no difference between LMA or FM or ETT. For the important
outcome of “morbidity” we have identified very low quality evidence from the same
RCT, showing more trauma tissue comparing with LMA vs ETT (OR 2.43 (0.51 – 11.51).
We did not identify any evidence to address the critical outcome of indicators of brain
injury or long term outcomes comparing LMA, FM or ETT as a secondary device.
TREATMENT RECOMMENDATION
LMA compared to FM as a primary device for infants at term requiring positive
pressure ventilation for resuscitation
We suggest that the use of Laryngeal Mask Airway as a primary device for respiratory
support in delivery room for newborns at term requiring positive pressure ventilation
during neonatal resuscitation as feasible and safe, but there is not enough evidence to
recommend it instead of Face Mask (weak recommendation from low quality of
evidence).
There is limited evidence, however, to evaluate its use for premature infants. The
laryngeal mask airway has not been evaluated in the setting of meconium-stained
amniotic fluid, during chest compressions, or for administration of emergency
intratracheal medications
The laryngeal mask airway should be considered during resuscitation of the newborn if
face mask and/or endotracheal intubation is unsuccessful or not feasible.
LMA compared to ETT as a secondary device for infants at term requiring positive
pressure ventilation for resuscitation
We suggest that the use of Laryngeal mask airway as a secondary device for respiratory
support in the delivery room for newborns at term requiring positive pressure
ventilation during neonatal resuscitation as feasible and safe, but there is not enough
evidence to recommend it instead of endotracheal intubation (weak recommendation
from very low quality evidence).