Use of Supraglottic Airways During Chest Compressions

Red Cross Guidelines

In newborn infants 34 or more weeks’ gestation receiving chest compressions despite optimized positive pressure ventilation, if placement of an endotracheal tube is not possible or is unsuccessful, ventilation during compressions with a supraglottic airway device is reasonable. (Good practice statement)

Insights

Supraglottic airway devices are increasingly used in neonatal resuscitation as an alternative to face mask ventilation, which can be compromised by mask leaks and reduced tidal or minute volumes. While they facilitate ventilation, supraglottic airway devices are not considered definitive airways as are endotracheal tubes. However, intubation during chest compressions is technically challenging and requires expertise that may not be immediately available.

Although no clinical trials have evaluated supraglottic airway device use in term or late preterm newborns during chest compressions, indirect evidence from animal, pediatric and adult studies suggests that supraglottic airway devices can provide ventilation comparable to tracheal tubes, may allow faster airway placement, and are associated with similar or improved rates of return of spontaneous circulation. Limited data also suggest that epinephrine administration through a supraglottic airway device may be as effective as via a tracheal tube.

A new good practice statement reflects this balance. While endotracheal intubation remains the definitive airway, supraglottic airway device placement is a reasonable alternative when skilled personnel are unavailable or intubation attempts are unsuccessful during chest compressions in newborns 34 weeks’ or more gestation.