A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department

Abstract

Study objective We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8). When the C-MAC was used as a video laryngoscope, a Cormack-Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%). The C-MAC was associated with immediately recognized esophageal intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%). Conclusion When used for emergency intubations in the ED, the C-MAC was associated with a greater proportion of successful intubations and a greater proportion of Cormack-Lehane grade I or II views compared with a direct laryngoscope.

Using Video‐recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children

“…[1][2][3] Video laryngoscopy has been demonstrated to improve first-pass and ultimate success and decrease iatrogenic airway trauma during endotracheal intubation in adults. [4][5][6] In addition to clinical benefit, the ability to review videos captured during laryngoscopy provides a unique opportunity to assess metrics related to procedural performance and quality of care. The C-MAC video laryngoscope blades (Karl Storz, Tuttlingen, Germany) are structurally similar to those of conventional laryngoscopes, but allow continuous recording of intubations.…”

Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

“…The editorial published in Anaesthesiology journal in 2012, emphasize the need for more randomized studies in order to establish clearly the benefits and advantages of the video laryngoscopes over the conventional laryngoscopes. 5,6 The C-MAC ® (Karl Storz Endoscopy, Tuttlingen, Germany) uses the same blade as conventional Macintosh laryngoscope except that, in the former the visualization of glottis is indirect on the video screen and the latter being direct. Even though, good view can be obtained in the indirect laryngoscopes, multiple attempts may be required for successful tracheal intubation.…”

Airway management of an open penetrating neck injury

“…30 There is no description of videolaryngoscopy use in PNI, nor is it obvious that videolaryngoscopy would overcome the difficulties associated with blood and anatomic distortion. The rigid stylet used with videolaryngoscopes may extend the traumatic airway disruption if it advances through the glottis beyond the limits of visual monitoring.…”