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

Erkan Goksu; Taylan Kilic; Gunay Yildiz; Aslihan Unal; Mutlu Kartal

doi:10.1016/j.tjem.2016.02.001

Erkan Goksu¹, Taylan Kilic², Gunay Yildiz³, Aslihan Unal¹, Mutlu Kartal¹

¹Department of Emergency Medicine, Akdeniz University School of Medicine, Antalya, Turkey
²Emergency Service, Antalya Training And Research Hospital, Turkey
³Kilis State Hospital, Turkey

Keywords: Airway management; Emergency medicine; Video laryngoscope

Abstract

Objectives: We 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 methods: This 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).

Results: During 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 conclusion: The overall success rates were similar. The C-MAC demonstrated improved glottic view and decrease in esophageal intubation rate.