A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department
Annals of Emergency Medicine,  Clinical Article

Sakles JC et al. – When used for emergency intubations in the emergency department (ED), the C–MAC was associated with a greater proportion of successful intubations and a greater proportion of Cormack–Lehane grade I or II views compared with a direct laryngoscope.

Methods
  • This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28–month period in an academic ED.
  • After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt.
  • Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device.
  • An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube.
  • The primary outcome measure was ultimate success.
  • Secondary outcome measures were first–attempt success, Cormack–Lehane view, and esophageal intubation.
  • Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first–attempt success.

Results
  • During the 28–month study period, 750 intubations were performed with either the C–MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade.
  • Of these, 255 were performed with the C–MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device.
  • The C–MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%).
  • A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%).
  • In the multivariate regression model, with a propensity score included, the C–MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first–attempt success (odds ratio 2.2; 95% CI 1.2 to 3.8).
  • When the C–MAC was used as a video laryngoscope, a Cormack–Lehane grade I or II view (video) was obtained in 117 of 125 cases (93.6%; 95% CI 87.8% to 97.2%), whereas when a direct laryngoscope was used, a grade I or II view was obtained in 410 of 495 cases (82.8%; 95% CI 79.2% to 86.1%).
  • The C–MAC was associated with immediately recognized esophageal intubation in 4 of 255 cases (1.6%; 95% CI 0.4% to 4.0%), whereas a direct laryngoscope was associated with immediately recognized esophageal intubation in 24 of 495 cases (4.8%; 95% CI 3.1% to 7.1%).

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Otolaryngology

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Otolaryngology Articles

1 Efficacy of honey in reduction of post tonsillectomy pain, randomized clinical trial International Journal of Pediatric Otorhinolaryngology , October 24, 2014    Clinical Article
Exclusive Author Commentary

2 Ubiquitous aspirin: A systematic review of its impact on sensorineural hearing loss Otolaryngology - Head and Neck Surgery, November 14, 2014    Review Article

3 Topical intranasal corticosteroids and growth velocity in children: a meta-analysis International Forum of Allergy & Rhinology, November 11, 2014    Evidence Based Medicine

4 Treatment of aging vocal folds: novel approaches Current Opinion in Otolaryngology and Head & Neck Surgery, November 26, 2014    Review Article

5 Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings International Forum of Allergy & Rhinology, November 24, 2014    Clinical Article

6 The effects of pregnancy on nasal physiology International Forum of Allergy & Rhinology, November 10, 2014    Clinical Article

7 Incidence of different causes of benign obstruction of the salivary glands: retrospective analysis of 493 cases using fluoroscopy and digital subtraction sialography British Journal of Oral and Maxillofacial Surgery, November 21, 2014    Clinical Article

8 Long-term follow up of sudden sensorineural hearing loss patients treated with intratympanic steroids: audiological and quality of life evaluation The Journal of Laryngology & Otology, September 9, 2014    Clinical Article

9 Coagulase-negative Staphylococcus culture in chronic rhinosinusitis International Forum of Allergy & Rhinology, November 13, 2014    Clinical Article

10 Olfactory outcomes in chronic rhinosinusitis with nasal polyposis after medical treatments: a systematic review and meta-analysis International Forum of Allergy & Rhinology, November 19, 2014    Evidence Based Medicine    Review Article

11 Medical reversal of chronic sinusitis in a cystic fibrosis patient with ivacaftor International Forum of Allergy & Rhinology, November 18, 2014    Clinical Article

12 Standalone balloon dilation versus sinus surgery for chronic rhinosinusitis: A prospective, multicenter, randomized, controlled trial with 1-year follow-up The American Journal of Rhinology & Allergy, August 1, 2014    Clinical Article

13 Intratympanic dexamethazone versus high dosage of betahistine in the treatment of intractable unilateral Meniere's disease American Journal of Otolaryngology, November 12, 2014    Clinical Article

14 Stroke after adenotonsillectomy in patients with undiagnosed moyamoya syndrome JAMA Otolaryngology—Head & Neck Surgery, October 9, 2014    Clinical Article

15 Intranasal steroid injections and blindness: Our personal experience and a review of the past 60 years The Laryngoscope, November 20, 2014    Review Article

16 Specific immunotherapy for allergic rhinitis in children Current Opinion in Otolaryngology and Head & Neck Surgery, November 25, 2014    Review Article

17 'Pacemaker for the tongue' offers minimally-invasive, less painful approach in sleep apnea treatment Baylor College of Medicine News, November 12, 2014

18 Are ear infections overtreated in white children? University of Utah Health Care, November 18, 2014

19 CT arteriography and venography in the evaluation of pulsatile tinnitus with normal otoscopic examination The Laryngoscope, November 24, 2014    Clinical Article

20 A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo Audiology and Neurotology, November 13, 2014    Clinical Article

Indexed Journals in Otolaryngology: American Journal of Otolaryngology, Clinical Otolaryngology, Auris Nasus Larynxmore