Comparative evaluation of CMAC and Truview picture capture device for endotracheal intubation in neonates and infants undergoing elective surgeries: A prospective randomized control trial

Abstract

Summary Background Videolaryngoscopy has an established role in difficult airway management in adults. However, there is limited literature to support their efficacy in children. The Truview Picture Capture Device has shown promising results for endotracheal intubation in infants in the past. The CMAC videolaryngoscope has launched its novel infant Miller blade, but its performance has not been assessed clinically for routine intubation in infants and neonates. We hypothesized that the CMAC videolaryngoscope would reduce the total time to intubation as compared to the Truview Picture Capture Device in neonates and infants. Methods After parental informed consent, 80 prospective infants posted for surgical procedures under general anesthesia were randomized to undergo intubation with either of the two. The two videolaryngoscopes were also compared in terms of time required for glottis view and intubation (primary outcome), modified Cormack and Lehane grade, first attempt and overall success rate, ease of intubation, number of attempts, and any complications. Results The CMAC significantly reduced the time required for glottic view [8 s (5.25‐9) vs 9 s (6.5‐12); P = 0.02] and intubation [22 s (18‐26) vs 26 s (21.5‐32); P = 0.003]. The median difference (95% CI) for time to tracheal intubation and time to glottic view was 4 s (1‐7) and 1 (0‐4). It also improved the ease of intubation, the Cormack‐Lehane grades, and first attempt success rate. Intubation with the CMAC was possible in 100% cases, whereas only 92.5% of patients could be intubated with the Truview. The failed intubations with the Truview could be successfully intubated with the CMAC. Conclusion The CMAC Miller blade reduced the total time taken for tracheal intubation and intubation difficulty as compared to the Truview Picture Capture Device and may be a better tool for intubation in infants.

Evolution of videolaryngoscopy in pediatric population

“…C-MAC VL also had a lower IDS score (intubation difficulty score) when compared to conventional Miller blade due to improved CL grade, reduced laryngeal pressure and decreaesed lifting force. [ 27 ] In a Prospective randomized trial on intubation in lateral position in infants (n = 64), CMAC VL decreased the time to intubation 6.1 s (1.7-10.4) and reduced the IDS as compared to conventional Miller blade. [ 28 ]…”

“…Similar findings of increased intubation times leading to desaturation and fogging as a cause of intubation failure were reported in another recent study. [ 27 ]…”

“…VL is associated with a faster learning curve thereby resulting in a higher success rate for intubations and quality assurance by novice physicians. [ 3 27 ] VL with macintosh design can assist with the learning of both conventional and indirect laryngoscopy, and this may decrease airway morbidity by preventing additional intubation attempts in case of difficulty. The VLs not only have better effectiveness but the possibility of theentire operating room personnel watching the intubation procedurewhich in turn, could enhance teaching, improve team dynamics, hasten the response in crisis and mayimprove overall patient safety.…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Einige SR deuten auf ein erhöhtes Risiko einer verlängerten Intubationszeit und einer erfolglosen Intubation mit Videolaryngoskopie hin [192][193][194]. Neuere RCT-und Beobachtungsstudien deuten auf einen Vorteil hin, aber die Evidenzen bleiben widersprüchlich [195][196][197][198][199][200][201][202] [203]. Bei kleinen Kindern kann die Inzidenz von Rhythmusstörungen verringert werden, wenn Atropin zusätzlich zu den für die Notfallintubation verwendeten Medikamenten gegeben wird [204].…”

Comparative efficacy of C‐MAC® Miller videolaryngoscope versus McGrath® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial

“…10 The C-MAC Miller sizes "0" and "1" (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) have a straight blade with an 80° angled view camera that provides improved intubating conditions in infants and neonates. [12][13][14] McGrath MAC ® VL (McGrath; Medtronic, Minneapolis, USA) is exceptionally lightweight, with a disposable Macintosh type blade, and an integrated monitor attached to its handle. The size "1" blade of McGrath is a relatively recent addition to the armamentarium of an anesthesiologist managing airway of neonates and infants and has not been formally evaluated in randomized trials.…”