Supraglottic airway (SGA)

1.8.2. Supraglottic airway – SGA

(Also known as a laryngeal mask)

ANZCOR 2021: Guideline 13.1 and 13.5 (April 2021)

 All personnel who attend births should be trained in newborn resuscitation skills which include basic measures to maintain an open airway, ventilation via a face mask or supraglottic airway (SGA) device and chest compressions. [Good Practice Statement].

ANZCOR suggests that a supraglottic airway should be considered during resuscitation of the term and near-term newborn (≥34 weeks, approximately 2000 grams) if face mask ventilation is unsuccessful. [CoSTR 2015, weak recommendation, low certainty of evidence]

The supraglottic airway may be considered as a primary alternative to a face mask for positive pressure ventilation among newborns weighing more than 2000 grams or delivered ≥34 weeks’ gestation, although there is insufficient evidence to support its routine use in this setting. [Good Practice Statement]

Supraglottic airway: Indications for use

Insertion of a supraglottic airway (SGA) may be considered in the following clinical situations to safely secure and maintain control of the airway:

• Anticipated or unexpected difficult airway
• A newborn with an airway anomaly (known or suspected)
• Face mask ventilation is unsuccessful: large mask leak/no chest rise/heart rate not improving
• Endotracheal intubation is unsuccessful
  • Consider inserting an SGA after 2 intubation attempts
• Endotracheal intubation is not feasible because the personnel do not have skills in newborn intubation.
  • Insertion of an SGA should be considered by medical/midwifery/nursing clinicians who are trained to insert an SGA

Suitable infants:

• Term or near-term newborns
• ≥ 34 weeks’ gestation
• ≥ 2000 g birth weight (>1500 g BW in recent published evidence)

Size: 

Size 1 SGA is recommended for newborn infants up to 5kg birth weight.

An un-cuffed SGA is recommended (for simplicity of insertion)

Contradictions:

• The safety and efficacy of administering adrenaline via an SGA has not been determine and is not recommended

Types of supraglottic airways:

• Un-cuffed (preferred choice for simplicity of insertion)
• Cuffed

Un-cuffed	Cuffed
i-gel® Size 1, 2-5 kg birth weight	Laryngeal mask airway™  Size 1, <5 kg birth weight
i-gel® Pink= Newborn size 1

Supraglottic airway insertion

We have developed a short series of slides which you may wish to review on insertion of a supraglottic airway (SGA).

Supraglottic Airway_August 2021 

Assessing the effectiveness of ventilation

• Use clinical signs similar to those used for endotracheal ventilation:
  • Chest wall movement
  • Improvement in heart rate
  • Improvement in oxygenation
• In addition, the chest should be auscultated. [Good Practice Statement]

Potential adverse events/complications

• Inadequate alveolar ventilation – set PIP and PEEP may not be achieved if there is leak
• Gastric distension
• Potential for a vasovagal reaction