469 - Laryngeal Mask as Primary Airway Device in Neonatal Resuscitation: An Ovine Study

Publication Number: 1451.469

Srinivasan Mani, 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; Sylvia F. Gugino, SUNY at Buffalo, Buffalo, NY, United States; Nicole Bradley, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Mausma Bawa, University at Buffalo, Buffalo, NY, United States; Praveen Chandrasekharan, 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

Background: Rapid delivery of optimal tidal volume is a prerequisite for chest compression (CC) and epinephrine to produce the desired effects in neonatal cardiopulmonary resuscitation (CPR). However, the effective use of standard ventilation interfaces - namely, facemasks (FM) and endotracheal tubes (ET) - poses technical challenges. The laryngeal mask (LM), an alternative interface, was found to decrease the probability of resuscitation failure compared to FM and reduce the need for ET. While the evidence suggests LM may be a better interface than FM and comparable to ET, endorsed by ILCOR and NRP in their 2025 guidelines, its efficacy as a primary interface in neonatal CPR has not been evaluated.

Objective: To compare the efficacy of the LM-first and LM-only approach in neonatal CPR to the standard of care in a lamb model of cardiac arrest by evaluating (A) survival, (B) duration of CPR, (C) adequacy of ventilation and oxygenation, and (D) systemic and pulmonary hemodynamics.

Design/Methods: Near-term lambs (GA139-140 days) after umbilical cord occlusion-induced cardiac arrest, per a standardized experimental protocol, were randomized to undergo CPR with either LM (i-gel -study arm) or FM for 2 minutes, followed by ET (FM/ET - control arm) following NRP guidelines until return of spontaneous circulation (ROSC) or 20 minutes. A respiratory function monitor continuously recorded ventilatory parameters. Arterial blood gas, pulmonary, and systemic hemodynamic changes were monitored throughout CPR and 1 hour post-ROSC.

Results: Thirteen lambs were randomized, asphyxiated, and resuscitated (7 in LM vs. 6 in FM/ET groups). Gestational age, birth weight, and gender distribution were comparable among the groups. Baseline acid-base status, time to asystole were homogeneous. All the lambs in both groups achieved ROSC. Three out of 7 lambs achieved ROSC without the need for epinephrine in the i-gel group, compared to none in the FM/ET group. The median duration of CPR was 5m 41s (5m 16s - 6m 15s) in the i-gel group and 6m 25s 6m 3s-6m 59s in the FM/ET group (p=0.274) after nearly half the study was completed. The respiratory parameters during resuscitation and in the post-resuscitation phases did not differ between the groups. Oxygenation and ventilation were adequate and comparable between the groups, without a significant difference in carotid or pulmonary blood flow during or 60 minutes after resuscitation.

Conclusion(s): The interim results of our translational study suggest that LM (i-gel) as the primary ventilation interface for advanced neonatal CPR is a promising alternative to the standard of care in terms of efficacy.

Table 1a. Baseline characteristics
Table 1a. Baseline characteristics

Table 1b. Analysis of primary and secondary outcomes
Table 1b. Analysis of primary and secondary outcomes

Figure 1. Oxygenation, ventilation, cerebral and pulmonary hemodynamic patterns
Figure 1. Oxygenation, ventilation, cerebral and pulmonary hemodynamic patterns