Laryngeal mask airway versus facial mask for pediatric resuscitation: A Meta-Analysis

Abstract

Introduction: Respiratory arrest is the most common cause of cardiac arrest in children. Thus, immediate lung ventilation is critical for successful resuscitation. Although the facial mask (FM) ventilation is the first-line method for pediatric resuscitation, it does not always guarantee successful ventilation. Recently, a laryngeal mask airway (LMA) is commonly used in various clinical situations, but evidence on efficacy or safety of LMA in pediatric resuscitation as compared with the FM is still lacking. The following meta-analysis was performed to compare the LMA and FM for successful resuscitation in children.

Methods: Prospective randomized, quasi-randomized, or randomized cross-over trials comparing LMA and FM for resuscitation in children were selected for analysis. Two reviewers independently searched MEDLINE, EMBASE, CENTRAL, and other databases, assessed the risk of bias, and extracted data from the included trials. Dichotomous and continuous variables were presented as relative risk (RR) and mean difference (MD), respectively, with 95% CI, and combined them with the random-effects meta-analysis. The primary outcome was the incidence of successful resuscitation. The secondary outcomes were the times taken to successful ventilation or resuscitation, incidence of successful chest movement, length of total positive pressure ventilation (PPV), and 5-min Apgar score. Any adverse events associated with resuscitation were also examined. Combined effect sizes of each outcome were presented as RRs or MDs, 95% CIs, P values, and numbers of included studies and participants.

Results: After screening 956 citations, 7 studies involving 1282 children undergoing resuscitation using LMA or FM was included. The incidence of successful resuscitation was significantly higher when using the LMA than the FM (RR 1.14, 95% CI 1.04 to 1.25, P = 0.005

1123 children in 5 studies). Although positive ventilation was achieved more slowly when using the LMA than the FM (MD 9.66 s, 95% CI 2.17 to 17.15 s, P = 0.01

301 children in 3 studies), the time to successful resuscitation was shorter (MD -2.6 s, 95% CI -4.47 to -0.74 s, P = 0.006

1073 children in 4 studies). In the LMA group, gastric distension was less, but vomiting was more frequent.

Conclusion: In this meta-analysis, although the time to positive ventilation was 9.66 s longer, the success rate of resuscitation was 14% higher and the time to successful resuscitation was 2.6 s shorter when using the LMA than the FM. Therefore, the LMA may be an effective alternative to the FM for successful resuscitation in children.