The Supreme Laryngeal Mask Airway™ (LMA): A new neonatal supraglottic device: Comparison with Classic and ProSeal LMA in a manikin

doi:10.1016/j.resuscitation.2011.07.032

Resuscitation

Volume 83, Issue 1, January 2012, Pages 97-100

https://doi.org/10.1016/j.resuscitation.2011.07.032 Get rights and content

Abstract

Aim

The study aims to compare the performances (ease of insertion, time to establish effective ventilation and maximal inflation pressure) of classic™ (cLMA), ProSeal™ (PLMA) and Supreme™ (SLMA) Laryngeal Mask Airway when used in a neonatal airway management manikin by inexperienced delivery room trainees. The quality of the three devices, as perceived by participants, was also evaluated.

Methods

Health-care professional trainees were given a brief supervised training with the three devices. Every trainee was then observed positioning each of the three different LMAs in a single occasion. Success rate, time (IT) and maximal inflation pressure (PI_max) were recorded by a single unblinded observer. A 4-point scale was used to rate participants’ perceived quality.

Results

A total of 40 health-care professional trainees participated in the study.

There were five, three and one failed insertions at the first attempt with the cLMA, PLMA and SLMA, respectively. No failures to establish an effective airway within three attempts were recorded. The success rate at first attempt was comparable among the three devices. The mean IT was significantly lower with the SLMA as compared with PLMA (p < 0.01), but not to cLMA. The mean PI_max was higher with SLMA than with cLMA and PLMA (p < 0.01). The ease of insertion as well as the effectiveness of ventilation were perceived by the participants as superior with SLMA as compared with cLMA and PLMA (p < 0.01).

Conclusions

Neonatal SLMA is superior to PLMA in terms of time to establish effective ventilation; furthermore, maximal inflation pressure and quality perceived by the operator are higher with neonatal SLMA than with cLMA and PLMA. These manikin data could provide a useful guide for planning potential future clinical research involving the newly developed supraglottic device in neonates.

Section snippets

Subjects

Institutional board review approval was obtained. Health-care professional trainees of our regional perinatal level III centre, with no previous experience in LMA usage, were recruited.

Study design

The procedure was conducted based on a previous manikin study protocol.⁵ Participants received a standardised 15 min training on the cLMA, PLMA and SLMA for neonatal resuscitation. All LMAs were size 1, which are indicated for neonates weighting 2000–5000 g, according to the manufacturer's instructions.¹⁴ Training

Results

A total of 40 health-care professional trainees (12 paediatric residents, 15 anaesthesia residents, seven midwifery trainees and six nurse trainees) participated in the study.

The IT was significantly lower with the SLMA

Discussion

This is the first study that evaluates the novel neonatal size 1 SLMA in a manikin. Our results show that SLMA performances were superior to those of cLMA and PLMA in terms of PI_max and ease of insertion. Furthermore, participants expressed the highest satisfaction when using the SLMA.

Rapid establishment of a patent airway and effective ventilation is of utmost importance in neonatal resuscitation.¹ Previous adult studies showed that these goals could be less invasively achieved with a

Conflict of interest statement

DT, MP, ND, CO and MM are involved in teaching for courses supported by an educational grant from The Laryngeal Mask Company Limited, UK.

Financial disclosure

The authors have no financial disclosure to report. No funds were received for this work. The Supreme LMA prototypes were provided by The Laryngeal Mask Company Limited, UK.

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Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA- ProSeal™ and the LMA Classic™ in an airway management manikin

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Cited by (25)

Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey
2023, Resuscitation Plus
Citation Excerpt :
Training healthcare workers how to insert the LMA is much faster and easier than training them how to use tracheal intubation.29,30 In addition, studies show that brief training results in high rates of success on the first attempt of use of LMA because of ease of insertion and effectiveness of ventilation.31–33 Our study will need to be repeated after the introduction of LMA training by BNRP to see whether knowledge dissemination changes the availability and use of the device in the Brazilian neonatal settings.
The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals’ familiarity in using LMA in Brazil, this study aimed to describe the health professionals’ knowledge and practice of using LMA, who provide neonatal care in the country.
An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, ^and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room.
We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use.
This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
The Pediatric Airway
2019, A Practice of Anesthesia for Infants and Children
This chapter reviews the developmental anatomy and physiology of the pediatric upper airway as it relates to the practice of pediatric anesthesia. Differences between the pediatric and adult airways are important determinants of anesthetic techniques. Knowledge of normal developmental anatomy and physiologic function is required to understand and manage both the normal and the pathologic airways of infants and children. Techniques of mask ventilation, oral and nasal airway placement, use of supraglottic devices, and tracheal intubation are reviewed for normal and anatomically abnormal pediatric patients.
The Pediatric Airway
2018, A Practice of Anesthesia for Infants and Children
This chapter reviews the developmental anatomy and physiology of the pediatric upper airway as it relates to the practice of pediatric anesthesia. Differences between the pediatric and adult airways are important determinants of anesthetic techniques. Knowledge of normal developmental anatomy and physiologic function is required to understand and manage both the normal and the pathologic airways of infants and children. Techniques of mask ventilation, oral and nasal airway placement, use of supraglottic devices, and tracheal intubation are reviewed for normal and anatomically abnormal pediatric patients.
Paediatric supraglottic airway devices update
2017, Revista Colombiana de Anestesiologia
Con posterioridad a la introducción de la máscara laríngea en los años 1980 se han venido desarrollando varios dispositivos similares, los cuales han cambiado el manejo de la vía aérea pediátrica en anestesia. Este artículo de reflexión describe y examina los distintos dispositivos supraglóticos para la vía aérea pediátrica disponibles actualmente en el Reino Unido.
Este artículo de opinión se basa en una revisión de los artículos que tratan el tema de los dispositivos supraglóticos para la vía aérea pediátrica, realizada en las bases de datos Cochrane, Medline, Ovid y PubMed y también en los libros de texto.
A medida que se desarrollan dispositivos nuevos con indicación clara de pertinencia clínica y ventajas genuinas, se necesitarán también estudios de alta calidad a fin de mejorar las características de dichos dispositivos.
Following the introduction of the laryngeal mask in the 1980's, several similar devices have been developed, changing paediatric airway management under anaesthesia. This reflective article describes and examines the different paediatric supraglottic airway devices currently available in the U.K.
This perspective article is based on a narrative review of articles that discussed paediatric supraglottic airway devices using Cochrane, Medline, Ovid and PubMed databases as well as text books.
As new devices continue to be developed with a clear indication of clinical relevance and genuine advantages, so high quality research will also continue to be required in order to improve features in new devices.
The Role of Supraglottic Airways in Pediatric Emergency Medicine
2015, Clinical Pediatric Emergency Medicine
Citation Excerpt :
Compared with the LMA ProSeal, the LMA Supreme was found to be easier to insert and was associated with less pharyngeal injury in children.10 In a neonatal manikin study, the LMA Supreme was found to outperform the LMA Classic and LMA ProSeal.11 Compared with a newer second-generation device, the i-gel, the LMA Supreme was associated with higher first attempt success rates and faster times for successful insertion and had similar effectiveness in providing positive pressure ventilation.12
Supraglottic airway (SGA) devices have been shown to be a critical tool in pediatric airway management. The role of the SGA in emergency scenarios has increased dramatically, as its advantages are widely recognized. Studies have shown that SGAs are safe and effective in providing lifesaving oxygenation and gas exchange in both the normal and difficult pediatric airway and during resuscitation. They allow for rapid oxygenation and ventilation in the vast majority of children and are the ideal rescue device for failed facemask ventilation. They are also the ideal conduits to facilitate tracheal intubation. Newer SGA devices have design features to overcome limitations found in older devices. This narrative review aims to discuss the role of SGAs for pediatric emergency medicine.
Supreme Laryngeal Mask Airway versus Face Mask during Neonatal Resuscitation: A Randomized Controlled Trial
2015, Journal of Pediatrics
Citation Excerpt :
The SLMA was superior to the classic LMA with regard to insertion time and oropharyngeal seal pressure24; a further advantage is gastric access. A previous neonatal manikin study confirmed these findings, including higher level of satisfaction expressed by users.25 The results of this study add that a neonatal SLMA (size 1) is effective and safe also when used in the context of neonatal resuscitation.
To assess the effectiveness of supreme laryngeal mask airway (SLMA) over face mask ventilation for preventing need for endotracheal intubation at birth.
We report a prospective, randomized, parallel 1:1, unblinded, controlled trial. After a short-term educational intervention on SLMA use, infants ≥34-week gestation and/or expected birth weight ≥1500 g requiring positive pressure ventilation (PPV) at birth were randomized to resuscitation by SLMA or face mask. The primary outcome was the success rate of the resuscitation devices (SLMA or face mask) defined as the achievement of an effective PPV preventing the need for endotracheal intubation.
We enrolled 142 patients (71 in SLMA and 71 in face mask group, respectively). Successful resuscitation rate was significantly higher with the SLMA compared with face mask ventilation (91.5% vs 78.9%; P = .03). Apgar score at 5 minutes was significantly higher in SLMA than in face mask group (P = .02). Neonatal intensive care unit admission rate was significantly lower in SLMA than in face mask group (P = .02). No complications related to the procedure occurred.
In newborns with gestational age ≥34 weeks and/or expected birth weight ≥1500 g needing PPV at birth, the SLMA is more effective than face mask to prevent endotracheal intubation. The SLMA is effective in clinical practice after a short-term educational intervention.
Registered with ClinicalTrials.gov: NCT01963936.

View all citing articles on Scopus

^☆: A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.07.032.

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Simulation and educationThe Supreme Laryngeal Mask Airway™ (LMA): A new neonatal supraglottic device: Comparison with Classic and ProSeal LMA in a manikin☆

Abstract

Aim

Methods

Results

Conclusions

Section snippets

Subjects

Study design

Results

Discussion

Conflict of interest statement

Financial disclosure

Resuscitation

Resuscitation

Br J Anaesth

Br J Anaesth

Resuscitation

Resuscitation

Resuscitation

ILCOR advisory statement: resuscitation of the newly born infant

Pediatrics

2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 7. Neonatal resuscitation

Resuscitation

International guidelines for neonatal resuscitation: an excerpt from the guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care: international consensus on science

Pediatrics

Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA- ProSeal™ and the LMA Classic™ in an airway management manikin

Pediatr Anesth

Simulation and education
The Supreme Laryngeal Mask Airway™ (LMA): A new neonatal supraglottic device: Comparison with Classic and ProSeal LMA in a manikin☆