Clinical Experience With the C-MAC and GlideScope in a Pediatric Emergency Department Over a 10-Year Period

Pacheco, Garrett S.; Patanwala, Asad E.; Mendelson, Jenny; Sakles, John C.

doi:10.1097/pec.0000000000001911

Cited by 10 publications

(12 citation statements)

References 40 publications

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“…2021; 31(4):e108316. tion in pediatric patients aged < 18 years in the emergency department (13). Despite the longer time to intubate in the GlideScope ® group, there was no difference in terms of additional maneuvers required to improve intubation, such as external laryngeal manipulation, and no additional airway adjunct was required.…”

Section: Discussionmentioning

confidence: 86%

GlideScope® Versus C-MAC® Video Laryngoscopy in Pediatric Intubation. Does Time Matter?

et al. 2021

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Background: The emergence of video laryngoscopy in the management of pediatric airways has been invaluable as it has been known that these patients are prone to airway complications. Video laryngoscopes are proven to improve glottic view in both normal and difficult airways in pediatric patients. The time taken to intubate using these devices is inconsistent. Objectives: This study was designed to compare the time to intubate using two common video laryngoscopes, C-MAC®, and GlideScope®, aimed at pediatric patients age 3 - 12 years old. Methods: A Randomized controlled trial was conducted in 65 ASA I or II patients, aged 3 - 12 years old who underwent elective surgery using endotracheal tube. They were divided into group 1 patients who were intubated using C-MAC® video laryngoscope versus group 2 patients who were intubated with GlideScope® video laryngoscope. Laryngoscopists were all anesthetists with experience in both C-MAC® and GlideScope® intubation. Time to intubate and intubation attempts were measured. Any extra maneuver, airway complications, and laryngoscopist satisfaction scores were also recorded. Results: Total time to intubate was significantly longer in GlideScope® group than in C-MAC® group (P < 0.001). Both devices managed to achieve excellent glottic views. The first pass attempt success rate was similar between both devices. There was no difference between requirement of extra maneuvers to assist intubations. There were also no adverse events associated with all the intubations. The satisfaction score of anesthetists was comparable to each other. Conclusions: Even though intubation time using GlideScope® is longer, both devices give excellent glottic view, comparable success intubation, and anesthetists satisfaction score.

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Section: Discussionmentioning

confidence: 86%

GlideScope® Versus C-MAC® Video Laryngoscopy in Pediatric Intubation. Does Time Matter?

et al. 2021

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“…While the literature on pediatric patients presents a mixed picture, some recent observational studies suggest better performance of VL in practice in emergency intubation. [15][16][17][18] Previous pediatric VL studies have used age-appropriate VL blades, while our service used an oversized adult blade. Video laryngoscopy sizing has been taken directly from DL practice.…”

Section: Discussionmentioning

confidence: 99%

Out-of-Hospital Pediatric Video Laryngoscopy With an Adult Device

Miller¹,

Storey

Andrew

et al. 2023

Pediatr Emer Care

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Objectives: After introducing an adult video laryngoscope (VL) in our physician-paramedic prehospital and retrieval medical service, our quality assurance process identified this blade being used during pediatric intubations. We present a case series of pediatric intubations using this oversized adult VL alongside a contemporaneous group of direct laryngoscopy (DL) intubations. Methods:We performed a retrospective review of intubated patients 15 years or younger in our electronic quality assurance registry from January 1, 2017, to December 31, 2020. Data collected were demographic details, intubation equipment, drug doses, the number of intubation attempts, and complications. Results are presented according to those intubated with C-MAC4 VL (Karl Storz) alongside age-appropriate DL sizes.Results: Ninety-nine pediatric patients were intubated, 67 (67%) by CMAC4 and 32 (33%) by DL. Video laryngoscopy had a first-attempt success rate of 96% and DL 91%. A Cormach and Lehane view 1 or 2 was found in 66 VL (99%) and 29 DL patients (91%). Desaturation was reported in two VL and 1 DL patient.Conclusions: Adult VL became the most common method of intubation in patients older than 1 year during the study period. An adult C-MAC4 VL could be considered for clinicians who prefer VL when a pediatric VL is unavailable or as a second-line device if a pediatric VL is not present when intubating children older than 1 year.

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“…Intubation FPS has increased for children with the advent of VL, but to a smaller degree than in adults. [1][2][3][4] While VL allows for an improved view of the larynx compared with DL, directing the tracheal tube tends to be more challenging in children because of the cephalad positioned larynx and small size of the available space in the mouth to manipulate the tracheal tube. In addition, the hand-eye coordination required to direct the tube when performing VL is a learned skill that is distinctly different from placement of the tracheal tube under direct visualization during DL.…”

Section: Discussionmentioning

confidence: 99%

“…Prospective observational studies in children have demonstrated improved success with the use of video laryngoscopy (VL) compared with direct laryngoscopy (DL), although reported FPS rates are lower than those reported for adults. [1][2][3][4] Considering the unique cephalad position of the larynx in children, this may in part be due to difficulty directing the tracheal tube to the laryngeal inlet. Using airway adjuncts such as the pediatric rigid stylet (PRS) or a tracheal tube introducer (TTI) may aid with intubation to the cephalad positioned airway when performing VL.…”

mentioning

confidence: 99%

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

et al. 2022

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BackgroundPediatric emergency intubation is a high-acuity, low-occurrence procedure. Despite advances in technology, the success of this procedure remains low and adverse events are very high. Prospective observational studies in children have demonstrated improved success with the use of video laryngoscopy (VL) compared with direct laryngoscopy, although reported first-pass success (FPS) rates are lower than that reported for adults. This may in part be due to difficulty directing the tracheal tube to the laryngeal inlet considering the cephalad position of the larynx in infants. Using airway adjuncts such as the pediatric rigid stylet (PRS) or a tracheal tube introducer (TTI) may aid with intubation to the cephalad positioned airway when performing VL. The objectives of this study were to assess the FPS and time to intubation when intubating an infant manikin with a standard malleable stylet (SMS) compared with a PRS and TTI.MethodsThis was a randomized cross-over study performed at an academic institution both with emergency medicine (EM) and combined pediatric and EM (EM&PEDS) residency programs. Emergency medicine and EM&PEDS residents were recruited to participate. Each resident performed intubations on a 6-month-old infant simulator using a standard geometry C-MAC Miller 1 video laryngoscope and 3 different intubation adjuncts (SMS, PRS, TTI) in a randomized fashion. All sessions were video recorded for data analysis. The primary outcome was FPS using the 3 different intubation adjuncts. The secondary outcome was the mean time to intubation (in seconds) for each adjunct.ResultsFifty-one participants performed 227 intubations. First-pass success with the SMS was 73% (37/51), FPS was 94% (48/51) with the PRS, and 29% (15/51) with the TTI. First-pass success was lower with the SMS (−43%; 95% confidence interval [CI], −63% to −23%; P < 0.01) and significantly lower with the TTI compared with PRS (difference −65%; 95% CI, −81% to −49%; P < 0.01). First-pass success while using the PRS was higher than SMS (difference 22%, 7% to 36%; P < 0.01). The mean time to intubation using the SMS was 44 ± 13 seconds, the PRS was 38 ± 11 seconds, and TTI was 59 ± 15 seconds. The mean time to intubation was higher with SMS (difference 15 seconds; 95% CI, 10 to 20 seconds; P < 0.01) and significantly higher with the TTI compared with PRS (difference 21 seconds; 95% CI, 17 to 26 seconds; P < 0.01). Time to intubation with the PRS was lower than SMS (difference −7 seconds; 95% CI, −11 to −2 seconds; P < 0.01). The ease of use was significantly higher for the PRS compared with the TTI when operators rated them on a visual analog scale (91 vs 20 mm).ConclusionsUse of the PRS by EM and EM&PEDS residents on an infant simulator was associated with increased FPS and shorter time to intubation. Clinical studies are warranted comparing these intubation aids in children.

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Clinical Experience With the C-MAC and GlideScope in a Pediatric Emergency Department Over a 10-Year Period

Cited by 10 publications

References 40 publications

GlideScope® Versus C-MAC® Video Laryngoscopy in Pediatric Intubation. Does Time Matter?

GlideScope® Versus C-MAC® Video Laryngoscopy in Pediatric Intubation. Does Time Matter?

Out-of-Hospital Pediatric Video Laryngoscopy With an Adult Device

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

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