Endotracheal Intubation Using C-MAC Video Laryngoscope vs. Direct Laryngoscope While Wearing Personal Protective Equipment

Abstract

This study sought to determine whether the C-MAC video laryngoscope (VL) performed better than a direct laryngoscope (DL) when attempting endotracheal intubation (ETI) in the emergency department (ED) while wearing personal protective equipment (PPE). This was a retrospective single-center observational study conducted in an academic ED between February 2020 and March 2022. All emergency medical personnel who participated in any ETI procedure were required to wear PPE. The patients were divided into the C-MAC VL group and the DL group based on the device used during the first ETI attempt. The primary outcome measure was the first-pass success (FPS) rate. A multiple logistic regression was used to determine the factors associated with FPS. Of the 756 eligible patients, 650 were assigned to the C-MAC group and 106 to the DL group. The overall FPS rate was 83.5% (n = 631/756). The C-MAC group had a significantly higher FPS rate than the DL group (85.7% vs. 69.8%, p < 0.001). In the multivariable logistic regression analysis, C-MAC use was significantly associated with an increased FPS rate (adjusted odds ratio, 2.86; 95% confidence interval, 1.69–4.08; p < 0.001). In this study, we found that the FPS rate of ETI was significantly higher when the C-MAC VL was used than when a DL was used by emergency physicians constrained by cumbersome PPE.

Current trends in emergency airway management: a clinical review

“…GlideScope, King vision and McGrath MAC) with wearing level C PPE, but the overall ETI time tended to decrease in DL [31]. However, in a clinical study wearing the same level of PPE, the FPS rate of C-MAC VL was found to be higher than DL [42].…”

Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial

“…Additionally, the FPS rate was significantly higher in the VL group (94.3% vs. 58.6%, p < 0.001) [ 21 ]. In a recently published study, performed on 756 patients intubated within the Emergency Department by emergency physicians in PPE, Kim et al demonstrated a significantly increased FPS rate when a C-MAC VL was used instead of a MAC DL (85.7% vs. 69.8%, p < 0.001) [ 22 ].…”

Styletubation versus Laryngoscopy: A New Paradigm for Routine Tracheal Intubation

“…Both tools of VL and DL have been dedicated for use in patients with COVID-19, where the tracheal intubation is feasible. [148,149]. It is also noticed that the tracheal intubation procedure might be hampered by the personal protective equipment [150][151][152][153].…”