C-MAC video laryngoscope (KARL STORZ) use does not improve the success rate of first-attempt rapid sequence intubation compared with direct laryngoscopy, but visualization of the vocal cords is improved, new research suggests.
Video laryngoscopes were introduced into clinical practice to help visualize the airway and increase the success rate of airway management, according to researchers from the Cleveland Clinic. They conducted a single-center, randomized controlled trial to determine whether C-MAC video laryngoscope use improves the intubation success rate in patients requiring urgent rapid sequence intubation in the ER setting. The secondary outcome measure was the Cormack-Lehane (CL) grade of laryngeal view for both techniques.
“Typically in emergency rooms settings, these are the settings in which intubation is both urgent and relatively challenging,” said Sanchit Ahuja, MD, lead study author and clinical research fellow at the Cleveland Clinic. “Plus the success rate is very important … because we don’t have all the modalities in the emergency settings to check for the direct placement of the tube.”
The study included 150 patients (18-99 years of age) undergoing rapid sequence intubation in the ER. Patients were randomly assigned 1:1 to receive direct laryngoscopy or C-MAC video laryngoscopy. Three patients were excluded in the final analysis, leaving 74 in the C-MAC group and 73 in the direct laryngoscopy group.
All procedures were performed by three experienced anesthesiologists, according to Dr. Ahuja. Successful first-attempt intubation was achieved in 73 patients in the C-MAC group and in all patients in the direct laryngoscopy group. Time to intubation was 32±11 seconds for the C-MAC group compared with 31±9 seconds in the direct laryngoscopy group (P=0.51).
“We found there is no difference between both of these groups,” Dr. Ahuja said. “Although the C-MAC video laryngoscope does not improve the intubation success rate, it does improve the visualization of the vocal cords.”
The CL grade 1, defined in this study as full visualization of the vocal cords, was significantly more frequent with C-MAC use (80% vs. 50%), according to the researchers. They recommended using C-MAC video laryngoscopy as a first-line intubation approach in emergent settings.
Dr. Ahuja said future research would include following a larger patient population to validate the findings in this study.