Training for neonatal resuscitation with the laryngeal mask airway: a comparison of the LMA-ProSeal and the LMA-Classic in an airway management manikin

Background : Neonatal resuscitation is a mandatory skill for healthcare professionals involved in maternity suites. For ethical reasons, it is impossible to teach and practice airway management skills on neonates, and manikins are used for this purpose. The Classic Laryngeal Mask Airway TM (cLMA) is accepted as an effective device for airway management during neonatal resuscitation. A neonatal size of the LMA-ProSeal(TM) (PLMA) was recently produced, but there are no comparative data on its performance. We describe the comparison of the performances of the neonatal cLMA and the neonatal PLMA when used by different healthcare professionals in a dedicated airway management manikin. Methods: Thirty-five healthcare professionals, were given a brief description of the two devices followed by 15 min of supervised insertions on a single manikin. Every trainee was then instructed to insert both devices four times. The time from insertion to the first inflation of the artificial lungs (insertion time, IT) was recorded by a single unblinded observer. Results: No failed insertions were recorded. The success rates of the first attempt were higher with the PLMA than the cLMA (97.1% vs 92.1%; P < 0.01). The mean +/- SD (range) IT was significantly lower with the cLMA compared with the PLMA [10.47 +/- 2.85 (6-22) s vs 11.34 +/- 2.5 (7-18) s; P < 0.01]. The mean +/- SD (range) IT of the cLMA was 12.31 +/- 3.54 (7-22) s for the first positioning and 9.2 +/- 2.34 (6-16) s for the fourth (P < 0.01). The mean +/- SD (range) IT of the PLMA was 12.71 +/- 2.52 (8-18) s for the first positioning and 10.17 +/- 2.28 (7-14) s for the fourth (P < 0.01). There were no significant differences among groups. Conclusions: Both LMAs are easy to insert by different delivery-room workers. PLMA (with the introducer tool) has a higher success rate at first attempt than cLMA. Manikin ventilation was established equally without difference in performance among doctors, nurses, midwives. A brief manikin-training reduces the IT significantly. The longer IT of PLMA vs cLMA is without clinical relevance.