Laryngeal mask airway: an alternate option for all phases of neonatal resuscitation.
Laryngeal mask airway: an alternate option for all phases of neonatal resuscitation.
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DOI：
10.1038/s41390-021-01917-5
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发表时间：
2022-09
影响因子：
3.6
通讯作者：
Laskminrusimha, Satyan
中科院分区：
文献类型：
--
作者：
Vali, Payam;Laskminrusimha, Satyan
在全球范围内，所有新生儿死亡中有四分之一（估计每年250万）死于出生窒息，这仍然是低收入和中等收入国家新生儿发病率的主要原因。通过面罩早期启动正压通气（PPV）已显示可使> 90%的新生儿存活。1在极少数情况下，当非侵入性PPV不成功且新生儿仍然严重心动过缓（心率< 60次/分钟）时，国际复苏联络委员会（ILCOR）建议在开始胸外按压前进行气管内插管（ETT）。2插管是一项很难练习的技能。发展新生儿插管的熟练程度需要大量的经验3，基于模拟的培训尚未显示出为成功的新生儿插管做好准备。4喉罩通气道（LMA）是由英国麻醉师Archie Brain于1981年设计的，与面罩通气相比，喉罩通气是一种更实用的工具，并且比ETT插管的侵入性更小（图1）。LMA已在新生儿复苏中使用多年，由于其易于插入和通气可靠性，已被建议作为ETT的最佳替代方案。5使用人体模型的模拟研究表明，在15分钟的教育课程后，LMA可以在5秒的中位时间内成功插入。6临床上，95%（20/21）的新生儿在第一次尝试时在10 s内完成LMA插入，随后成功复苏。7在世纪之交，美国心脏协会和美国儿科学会在其指南中引入了LMA，目前ILCOR建议当面罩通气或插管不成功或不可行时，LMA可作为胎龄> 34周和/或出生体重> 2000 g的婴儿ETT插管的替代方案。2不同公司生产了几种不同类型的新生儿LMA，8但没有临床研究对不同的可用产品进行比较。
Globally, a quarter of all neonatal deaths (estimated at 2.5 million annually) die from birth asphyxia, which remains the leading cause of neonatal morbidity in low-and middle-income countries (LMICs). Early initiation of positive pressure ventilation (PPV) by face mask has shown to result in survival of> 90% of newborns. 1 In the rare circumstances when non-invasive PPV is unsuccessful and the newborn remains severely bradycardic (heart rate< 60 beats per minute), the International Liaison Committee on Resuscitation (ILCOR) suggests endotracheal tube (ETT) intubation prior to initiation of chest compressions. 2 Intubation is a difficult skill to practice. Developing proficiency at newborn intubation requires a significant amount of experience 3 and simulation-based training has not shown to prepare towards successful neonatal intubations. 4 The laryngeal mask airway (LMA) was designed in 1981 by British anesthesiologist, Archie Brain, as a more practical tool compared to face mask ventilation and less invasive than ETT intubation (Fig. 1). The LMA has been used in neonatal resuscitation for many years and owing to its ease of insertion and reliability in ventilation has been suggested as an optimal alternative to the ETT. 5 Simulation studies using manikins have demonstrated that an LMA can be successfully inserted in a median time of 5s after a 15-min educational session. 6 Clinically, LMA insertion was achieved on the first attempt within 10 s and followed by successful resuscitation in 95%(20/21) of newborns. 7At the turn of the century, the American Heart Association and American Academy of Pediatrics introduced the LMA in their guidelines, and currently ILCOR suggests the LMA as an alternative to ETT intubation in infants> 34 weeksL gestational age and/or birth weight> 2000 g when face mask ventilation or intubation is unsuccessful or not feasible. 2 Several different types of neonatal LMAs are manufactured by various companies, 8 but there are no clinical studies that have compared the different available products.
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DOI：
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