Feasibility of Laryngeal Mask Airway insertion during continuous chest compressions in neonatal resuscitation: a randomized crossover simulation study

Objective The objective is to assess the times taken for laryngeal mask airway (LMA®) placement, successful LMA placement, successful ventilation, and minute air leak amounts during interrupted (Scenario A) and continuous (Scenario B) chest compressions during simulated neonatal resuscitation. Material and methods In this randomized crossover simulation study, participating physicians performed both scenarios in a randomly allocated sequence on a high-fidelity neonatal manikin. The evaluated parameters were LMA placement times, first-attempt placement success, minute ventilation (MV), air leak volume, device-related complications, and procedural difficulty scores (VAS). Results A total of 32 physicians (16 attending anesthesiologists and 16 senior residents) completed the study. No statistical difference was observed between Scenario A and Scenario B regarding LMA insertion times (10.47 ± 2.00 s vs. 10.28 ± 1.82 s; p > 0.05) and first-attempt success rates (100% vs. 96.9%). Minute ventilation remained at the 0.50 L/min target in 27 of 32 participants under Scenario B (median 0.50 L/min in both scenarios). Air leak was lower in Scenario B (0.186 ± 0.040 vs. 0.164 ± 0.029 L/min; p < 0.001). Median VAS difficulty scores did not differ significantly between scenarios (1.0 vs. 1.0; p = 0.159), and no complications were observed. Although a 1.0 s learning effect was detected in the analyses, this momentum was distributed symmetrically to the data due to the crossover design. Conclusion In this simulated neonatal resuscitation model, LMA insertion during continuous chest compressions was feasible and maintained high first-attempt success. These findings should be interpreted as a proof-of-concept rather than formal statistical equivalence. The cause of the observed reduction in air leak under continuous compressions remains uncertain and may partly reflect instrument resolution limits rather than a true physiological effect. Furthermore, perceived procedural difficulty did not differ significantly between scenarios, and no device-related complications such as LMA folding or asymmetric chest rise were observed. Clinical Trial Registration : https://clinicaltrial.gov/ , identifier NCT07681960.