Efficacy of laryngeal mask epinephrine in neonatal resuscitation; an ovine study

Background: The efficacy of Laryngeal Mask Airway (LMA) epinephrine during neonatal resuscitation has not been studied. We hypothesize that LMA epinephrine is as effective as endotracheal tube (ETT) epinephrine. Methods: Sixteen fetal lambs were randomized in ETT or LMA group for ventilation and airway epinephrine administration after cord occlusion to induce complete cardiac arrest. Lambs were delivered and instrumented to continuously record pulmonary and systemic hemodynamics. After 5 min of cardiac arrest, lambs were resuscitated per NRP guidelines. Blood gases and plasma epinephrine levels were regularly measured during resuscitation. Results: Baseline characteristics were similar between the two groups. Incidence of return of spontaneous circulation (ROSC) was 5/8 (62.5%) in both groups; p = 1.00. Mean time to ROSC was similar in both groups; 6 minutes and 42 ± 65 s in the LMA group, and 6 min and 46 ± 51 s in the ETT group; p = 0.92. There was no difference in plasma epinephrine levels at baseline (LMA 0.7 ± 0.5 vs. ETT 0.8 ± 0.2 ng/mL; p = 0.88) and post-airway epinephrine administration (LMA 8.0 ± 3.1 vs. ETT 7.8 ± 4.6 ng/mL; p = 0.85). Conclusion: The use of LMA epinephrine for neonatal resuscitation is a suitable alternative to ETT epinephrine. Impact: The Neonatal Resuscitation Program (NRP) recommends a dose of airway epinephrine to be administered via the endotracheal tube (ETT) while intravenous access is being established. Endotracheal intubation is a highly skilled procedure. Laryngeal mask airway (LMA) is as effective in delivering positive pressure ventilation (PPV) and requires less training to achieve adequate competency to secure a stable airway. We show that LMA is a non-inferior method to deliver epinephrine during neonatal resuscitation in the ovine model.