I am a pediatric trainee at Karolinska University 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.
Of the 136 million babies born in the world annually, 5-8 million are estimated to need resuscitation at birth. Most newborn babies respond fairly promptly to drying, stimulation, as well as face-mask ventilation applied within the first minutes. Delaying this basic resuscitation will lead to a progressive decrease in heart rate and blood pressure, and potential death and/or brain injury in those infants that eventually start breathing. This is called birth asphyxia, and it results from an acute intrapartum hypoxic ischemic event.
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 newborn resuscitation is to maintain a patent airway and provide effective ventilation. However, resuscitation with face-mask ventilation requires adequate operator skills. To maintain such 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. This requires advanced operator skills and also the use of a laryngoscope. Endotracheal intubations are performed in the neonate only by skilled anesthesiologists or neonatologists.
Our research team works with the laryngeal mask airway. 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 endotracheal intubation as the first choice when face-mask ventilation is insufficient.