I am a pediatric trainee at Karolinska hospital and a registered PhD student in Global Pediatric Health since January 2020. I am part of a research group that focuses on neonatal resuscitation in low- and middle-income countries. The projects that I am involved in are based in Hanoi, Vietnam.
Failure to initiate spontaneous breathing at birth is thought to be secondary to primary apnoea, and the infant can be expected to respond fairly promptly to early intervention, e.g. drying, stimulation, as well as face mask ventilation applied within the first minutes. Delaying basic resuscitation in apneic newborns will lead to a progressive decrease in heart rate and blood pressure and potential death and/or cause of brain injury in those infants that eventually start gasping and/or regular breathing. This is called birth asphyxia and it results from an acute intra-partum hypoxic-ischemic event.
Of the 136 million babies born in the world annually, 5-8 million are estimated to need resuscitation at birth. Globally, birth asphyxia is responsible for close to 1 million deaths per year, of which almost all (98%) take place in low and middle-income countries. An even greater number suffer of moderate to severe multi-organ injuries. The main objective of neonatal resuscitation is to maintain a patent airway and provide effective positive pressure ventilation. However, neonatal resuscitation with face-mask ventilation requires adequate operator skills. To maintain adequate operator skill around the clock most obstetric and pediatric departments in high resource settings require annual retraining sessions for all staff members involved. For a long time, the only alternative, if face-mask ventilation fails, has been to intubate with an endotracheal tube, requiring advanced operator skills and also use of a laryngoscope. Endotracheal intubations are performed in the neonate only by skilled anesthesiologists or neonatologists.
The laryngeal mask airway was invented in the 1980's. It is inserted into the upper respiratory tract with the purpose to more easily and quickly ensure a free airway. We want to answer the question of whether a laryngeal mask airway should replace intubation as the first choice when face mask ventilation is insufficient.