Comparison of Laryngeal Mask Airway and Endotracheal Tube Placement in Neonates

Background: With increased use of non-invasive ventilation, there has been an increased focus of research on less invasive methods of delivering surfactant to neonates with respiratory distress syndrome. We investigated use of a laryngeal mask airway (LMA) for surfactant administration for infants requiring continuous positive airway pressure. Infants who met treatment failure criteria in the LMA and Control groups were intubated and given surfactant via an endotracheal tube (ETT).

Objective: This study compares placement of an LMA to placement of an ETT in neonates.

Methods: This is one component of a multicenter, randomized controlled trial. Infants were 28 0/7- 35 6/7 weeks gestation, ≥1250 grams and ≤36 hours old. Videotape of LMA (n=36) and ETT (n=31) placement were reviewed to determine the time and number of attempts required for successful placement. Heart rate (HR) and oxygen saturation (SaO₂) change from baseline were analyzed as measures of physiologic stability during placement.

Results: Duration of attempts was shorter for LMA as compared to ETT placement (32 sec vs 66 sec, p<0.001). Mean total procedure time for successful LMA placement was 88 sec as compared to 153 sec for ETT (p=0.065). Mean number of attempts for successful placement was fewer for LMA placement (1.5 vs 1.9, p<0.106). Physiologic parameters remained near baseline in both LMA and ETT groups with HR change +1 bpm and -1 bpm (p=0.333) and SaO₂ change -7% and -4% (p=0.361), respectively.

Conclusions: Placement of an LMA was well tolerated and required less time and fewer number of attempts as compared to the traditional method of endotracheal intubation.