Department of Pediatrics, University at Buffalo, Buffalo, New York.
Am J Perinatol. 2022 Jul;39(9):1008-1014. doi: 10.1055/s-0040-1721379. Epub 2020 Nov 29.
In 2015, Neonatal Resuscitation Program (NRP) recommended laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) in situations where the provider is "unable to intubate and unable to ventilate." LMA insertion is being taught in the NRP routinely. However, endotracheal intubation is the primary method considered as the standard of care in neonatal resuscitation. LMA insertion is a relatively simple procedure with an average insertion time of < 10 seconds. Newer generation LMA can have the added advantage of reducing the risk of aerosol generation and improving the safety of the providers. Only a few recent studies have evaluated the LMA insertion skills of neonatal resuscitation providers. We wanted to study the proficiency of NRP providers in the technique of LMA insertion. We hypothesized that NRP providers would have LMA insertion skills equivalent to the standard of care (ETT insertion).
DESIGN: A manikin-based study was done from July 2019 to December 2019. We enrolled 31 NRP providers with 1 or more years since the first certification and current valid NRP provider/instructor status. The participants were instructed to insert an ETT and LMA in the manikin. The procedures were video recorded. The time taken to insert and start ventilation with each device, including the number of attempts for successful insertion, was noted. A Likert scale questionnaire was filled by each participant indicating the level of confidence, perception of ease, and the ability to provide effective positive pressure ventilation (PPV) with each of the procedures. The paired -test, chi-square test, and Kruskal-Wallis' test were used for the statistical analysis.
Eight (25.8%) out of the 31 participants failed to insert any one of the devices. So, 23 providers were analyzed for the outcomes. We found that the mean duration taken to insert the ETT and LMA was not statistically different (32 vs. 36 seconds). LMA insertion had a higher failure rate compared with ETT. Providers did not perceive confidence to insert LMA when compared with ETT. They did not recognize LMA insertion as a more effortless procedure relative to endotracheal intubation. The providers felt that their ability to provide effective PPV using LMA was inferior to ETT.
The NRP certified providers in this study did not demonstrate proficiency in the insertion of LMA equivalent to the endotracheal intubation.
· LMA insertion skill was studied in NRP providers using a manikin.. · Providers had a higher frequency of failure in inserting LMA compared to ETT.. · Providers' perceived confidence and effectiveness of the LMA procedure were inferior to ETT..
2015 年，新生儿复苏项目（NRP）推荐喉罩气道（LMA）作为无法插管和无法通气时替代气管内导管（ETT）的方法。LMA 的插入已在 NRP 中常规教授。然而，气管内插管是新生儿复苏中被认为是主要方法，也是标准护理方法。LMA 的插入是一个相对简单的过程，平均插入时间<10 秒。新一代的 LMA 具有降低气溶胶生成风险和提高医护人员安全性的额外优势。只有少数最近的研究评估了新生儿复苏提供者的 LMA 插入技能。我们希望研究 NRP 提供者在 LMA 插入技术方面的熟练程度。我们假设 NRP 提供者将具有与标准护理（ETT 插入）相当的 LMA 插入技能。
这是一项基于模型的研究，于 2019 年 7 月至 2019 年 12 月进行。我们招募了 31 名 NRP 提供者，他们在第一次认证后有 1 年或以上的时间，并且目前具有有效的 NRP 提供者/讲师身份。参与者被指示在模型上插入 ETT 和 LMA。程序被录像。记录插入每个设备和开始通气所需的时间，包括成功插入的尝试次数。每位参与者填写了一份李克特量表问卷，表明对每个程序的信心水平、感知的易用性以及提供有效正压通气（PPV）的能力。采用配对 t 检验、卡方检验和 Kruskal-Wallis 检验进行统计分析。
31 名参与者中有 8 名（25.8%）未能插入任何一种设备。因此，对 23 名提供者进行了结果分析。我们发现，插入 ETT 和 LMA 的平均用时没有统计学差异（32 秒与 36 秒）。LMA 插入的失败率高于 ETT。与 ETT 相比，提供者对插入 LMA 没有信心。他们不认为 LMA 插入相对于气管内插管是一种更容易的程序。提供者认为，他们使用 LMA 提供有效 PPV 的能力不如 ETT。
在这项研究中，接受 NRP 认证的提供者在插入 LMA 方面没有表现出与气管内插管相当的熟练程度。
