475 - Comparative Performance of Newer Laryngeal Masks: A Neonatal Simulation Study

Publication Number: 1456.475

Saptadweepa Sanghamitra, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Justin Helman, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Munmun Rawat, University at Buffalo, Buffalo, NY, United States; Srinivasan Mani, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States

Background: Positive pressure ventilation (PPV) is pivotal for successful newborn resuscitation. The optimal airway interface that ensures rapid insertion & consistent tidal volume delivery remains uncertain. While the laryngeal mask (LM) offers advantages over facemasks & endotracheal tubes (ETs), comparative neonatal data are limited. Preliminary studies suggest that the cuffless i-gel may outperform other LM devices & facemasks. Evidence comparing newer LM devices, including i-gel, to ET remains scarce.

Objective: To compare the time to achieve target tidal volumes among seven LM devices & ET in a modified neonatal airway training manikin.

Design/Methods: This IRB-approved, consent-exempt simulation study used a Laerdal neonatal airway trainer modified for tidal volume measurement via Smart Lung Infant, Respiratory Function Monitor & T-piece resuscitator at a level IV NICU. The seven LM devices included two cuffless (i-gel, AerVia) & five cuffed LMAs (Unique, ProSeal, Supreme, Ambu AuraGain, Air-Q3). ET was evaluated using both video & direct laryngoscopes. Participants viewed instructional videos & completed hands-on training to ensure competency. Each participant inserted all devices & ventilated the manikin for 120 seconds (8 data points) at 40-60 breaths/min (25/5 cm H₂O). Ventilatory parameters were continuously recorded. Post-session, participants completed a perception survey on ease & confidence of use.

Results: Data were analyzed from 20 participants (planned N=50, in ongoing study). Participant characteristics are summarized in Table-1. Time to initiate the first breath varied by device; the cuffless LM (i-gel) consistently achieved the target tidal volume faster than cuffed LM devices & ET (video/direct) (Table-2a). First-attempt success rate was lowest with LMA Unique. The LMA Unique delivered set pressures & tidal volumes inconsistently. In contrast, i-gel demonstrated consistent pressure & volume delivery. Participants rated procedural ease & confidence significantly higher for cuffless LMs than cuffed LMs (Table-2b).

Conclusion(s): Cuffless LM, particularly i-gel, demonstrate better performance over cuffed LM & ET (video/direct) in achieving faster, more consistent ventilation with greater provider ease & confidence. A brief video & hands-on training session effectively enhanced provider confidence for cuffless LM use, while no such improvement was noted with cuffed LM. Cuffless LMs may represent the preferred neonatal PPV interface in future resuscitation protocols.

Table-1
Participant characteristics of the study

Table-2
Comparative performance of different laryngeal masks and participant perspectives on the use of different devices

Image-1
Seven laryngeal masks and modified neonatal airway training manikin used in the study