Comparison of the C-MAC video laryngoscope to the Macintosh laryngoscope for intubation of blunt trauma patients in the ED

Abstract

ObjectivesWe aimed to compare the performance of the C-MAC video laryngoscope (C-MAC) to the Macintosh laryngoscope for intubation of blunt trauma patients in the ED.Material and methodsThis was a prospective randomized study. The primary outcome measure is overall successful intubation. Secondary outcome measures are first attempt successful intubation, Cormack–Lehane (CL) grade, and indicators of the reasons for unsuccessful intubation at the first attempt with each device. Adult patients who suffered from blunt trauma and required intubation were randomized to video laryngoscopy with C-MAC device or direct laryngoscopy (DL).ResultsDuring a 17-month period, a total of 150 trauma intubations were performed using a C-MAC and DL. Baseline characteristics of patients were similar between the C-MAC and DL group. Overall success for the C-MAC was 69/75 (92%, 95% CI 0.83 to 0.96) while for the DL it was 72/75 (96%, 95% CI 0.88 to 0.98). First attempt success for the C-MAC was 47/75 (62.7%, 95% CI 0.51 to 0.72) while for the DL it was 44/75 patients (58.7%, 95% CI 0.47 to 0.69). The mean time to achieve successful intubation was 33.4 ± 2.5 s for the C-MAC versus 42.4 ± 5.1 s for the DL (p = 0.93). There was a statistically significant difference between the DL and C-MAC in terms of visualizing the glottic opening and esophageal intubation in favor of the C-MAC (p = 0.002 and p = 0.013 respectively).Discussion and conclusionThe overall success rates were similar. The C-MAC demonstrated improved glottic view and decrease in esophageal intubation rate.

Advancing emergency airway management practice and research

“…Video laryngoscopy generally improves the view of the glottis, without the need to align the airway axes to achieve a direct view from outside the patient's mouth, and can be considered as a rescue device. Nevertheless, the superiority of VL over DL for rescue intubation remains controversial …”

“…Although the use of VL has been increasing in the ED, there is a concern for the vulnerability of VL in patients with trauma where the airway could be contaminated by blood and vomitus . Although VL can provide better a glottic visualization compared to DL, VL should be used cautiously in this patient population according to the clinical practice guidelines for trauma management…”

Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature

“…After a failed first intubation attempt in the emergency department, C-MAC device is more successful at second attempt than the direct laryngoscope 51. However, all the available RCTs comparing C-MAC videolaryngoscope and direct laryngoscope for emergency intubation show no benefit on the intubation success rate and intubation time with C-MAC videolaryngoscope 49,53,54. The detailed reasons for inconsistent findings obtained from the observational and randomized controlled studies are unclear, but several important issues may be considered.…”

“…Several observational and retrospective studies from emergency department, prehospital and ICU patients showed that a V-MAC or C-MAC device, compared with a direct laryngoscope, was associated with a significantly better visualization of the larynx and a higher proportion of successful intubations, especially for patients with predicted difficult intubations 43–47. Furthermore, the use of C-MAC videolaryngoscope during emergency intubation was associated with significantly fewer esophageal intubations compared with direct laryngoscopy 43,48,49…”

“…As yet, there are 3 RCTs that have compared C-MAC videolaryngoscope and direct laryngoscopy for emergency intubation and all of them also show no benefit on intubation success rate and intubation time with the videolaryngoscope 49,53,54. In the trial by Sulser et al,53 rapid sequence emergency intubation was performed by experienced anesthetists.…”