Current evidence

Masks that fit over the laryngeal inlet (i.e., LMA) are effective for ventilating newborn full-term infants (level of evidence (LOE) 2; LOE 5). There are limited data on the use of these devices in small preterm infants (LOE 5). There is currently no evidence directly comparing LMA with bag-valve-bag-and-mask (BMV) ventilation during neonatal resuscitation. Data from two case series show that use of the LMA can provide effective ventilation in a time frame consistent with current resuscitation guidelines (LOE 5). A single randomized controlled trial found no significant difference between the LMA and tracheal intubation during resuscitation of babies by experienced providers after cesarean section (LOE 2). Case reports suggest that when ventilation via a face mask has been unsuccessful and tracheal intubation is unsuccessful or not feasible, the LMA may provide effective ventilation (LOE 5). A well-designed randomized controlled trial comparing the LMA with BMV during neonatal resuscitation is warranted.

Indication

PPV with face mask (bag or T-piece resuscitator) fails to achieve effective ventilation, and attempts at endotracheal intubation are either not feasible or unsuccessful (“can't ventilate and can't intubate”). Examples are:

• Congenital anomalies involving the mouth, lip, or palate, i.e., achieving a good seal with the bag and mask is difficult (head and neck cysts, cleft palate, Down syndrome, Beckwith–Wiedemann syndrome, Pierre Robin sequence, Treacher Collins syndrome, etc.)

• Anomalies of the mouth, tongue, pharynx or neck, when there is difficulty visualizing the larynx with a laryngoscope (head and neck cysts, Down syndrome, Beckwith–Wiedemann syndrome, Pierre Robin sequence, etc.)

• A very small mandible or relatively large tongue (e.g., Pierre Robin sequence, Beckwith–Wiedemann syndrome, Down syndrome, etc.)