Comparison of aerosol box intubation with C-MAC video laryngoscope and direct laryngoscopy—A randomised controlled trial

Abstract

Background and Aims: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a highly infectious disease and healthcare workers are at constant risk for contracting it. Nowadays, aerosol box is used in conjunction with WHO-recommended safety kits, to avoid health workers from getting SARS-CoV-2 infection during aerosol-generating procedures. In our study, we compared the ease of oral intubation with C-MAC video laryngoscope and direct laryngoscopy, when the aerosol box was used. The secondary objectives were to compare the incidence of airway loss, haemodynamic changes, number of attempts, and time required for intubation between these two techniques. Methods: This prospective randomised controlled study was conducted on 60 non-coronavirus disease (COVID) patients presenting for elective surgery under general anaesthesia. Patients were randomly assigned into two groups:C and D using a computer-generated random sequence of numbers by closed envelope technique. In group D, laryngoscopy was performed with Macintosh blade and in group C, with Storz® C-MAC video laryngoscope. Results: The ease of intubation was better (grade 1) in group C than D (68.6% vs. 31.4% respectively) with a P value of < 0.001. 10% of patients required more than one intubation attempt in group D compared to none in group C, but this difference was not statistically significant. The intubation time was comparable between the two groups. There were no incidences of loss of airway or failure to intubate in both groups. Conclusion: The use of C-MAC video-laryngoscopy resulted in easier orotracheal intubation as compared to intubation with direct laryngoscopy when the aerosol box was used.

Macintosh laryngoscope and i-view™ and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: a randomized crossover manikin study

“…Recently, Madabhushi et al enrolled 78 patients with normal airways who had no COVID-19 and found that by using Glidescope (Verathon, Bothell, WA, USA) with an external display, the tracheal intubation time with the aerosol box was non-inferior to that without the box [ 18 ]. Furthermore, Puthenveettil et al reported that C-MAC was easier to use than Macintosh for tracheal intubation with an aerosol box in 60 patients with normal airways without COVID-19 [ 19 ]. These results may suggest the potential benefit of an external display when performing tracheal intubation with an aerosol box in real patients [ 18 , 19 ].…”

“…Furthermore, Puthenveettil et al reported that C-MAC was easier to use than Macintosh for tracheal intubation with an aerosol box in 60 patients with normal airways without COVID-19 [ 19 ]. These results may suggest the potential benefit of an external display when performing tracheal intubation with an aerosol box in real patients [ 18 , 19 ]. Although an external display might be useful in clinical settings where visual conditions are more unfavorable, such as cloudy or well-worn eye-protective PPE or aerosol boxes, we could not confirm the advantage in this simulation study using a transparent acrylic box.…”

Simulation with a colour indicator to help reduce contamination during airway management in COVID-19 times: An experience from a tertiary centre in India

“…The aerosol box was used as part of the SOP as at the time of conducting this study, it was advocated as an adjunct to PPE. [ 22 23 24 ] Current emerging evidence on its use is conflicting. [ 25 26 ] Another limitation relevant to any simulation-based study is that it may not accurately reflect what occurs in actual clinical practice.…”

A comparison of intubating conditions for nasotracheal intubation with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope employing cuff inflation technique in adult patients

“…The laryngoscopic view is magnified for the operator and there is extra space for tube manipulation. [ 11 12 13 ] Nevertheless, the use of VL requires skill and practice. Inexperienced operators may face difficulty while performing NTI with VL leading to prolonged intubation time.…”