Authors: Lava Kumar P et al.
Journal: Cureus, Volume 18, Issue 1, Article e102723
- Summary
This randomized controlled trial compared first-attempt intubation success using the C-MAC videolaryngoscope versus Macintosh direct laryngoscopy when rapid sequence induction was performed by novice anesthesiology residents. The study focused on patients with normal airways undergoing elective or emergency procedures requiring RSI.
A total of 172 adult patients were randomized equally to videolaryngoscopy (VL) or direct laryngoscopy (DL). Intubations were performed by residents with 12–18 months of training who had completed structured lecture-based and simulation training. The primary endpoint was first-attempt intubation success, with secondary outcomes including glottic view quality, intubation time, need for adjunct maneuvers, airway injury, hypoxia, regurgitation, and hemodynamic responses.
First-attempt success was significantly higher in the VL group than the DL group (93% vs 67%). Videolaryngoscopy provided superior laryngoscopic views, with a greater proportion of Cormack-Lehane grade 1 views and higher Percentage of Glottic Opening scores. The need for optimal external laryngeal manipulation, release of cricoid pressure, and gum elastic bougie use was markedly lower with VL. Mucosal and dental injuries occurred only in the DL group.
Intubation time was numerically shorter with VL but not statistically different between groups. No episodes of hypoxia, regurgitation, or aspiration were observed in either arm. Hemodynamic responses differed, with DL associated with higher heart rate increases during and after intubation, whereas systolic blood pressure changes were similar between groups.
The study demonstrates that videolaryngoscopy improves first-pass success and airway conditions during RSI when performed by trainees, likely due to improved glottic visualization and a shorter learning curve. The familiar Macintosh-style blade of the C-MAC may allow residents to transition more easily from direct to video-assisted techniques.
What You Should Know
• Videolaryngoscopy substantially improves first-attempt success during resident-performed RSI.
• Better glottic views translated into fewer optimization maneuvers and airway adjuncts.
• Direct laryngoscopy was associated with higher airway trauma and greater sympathetic response.
• Intubation time was similar, suggesting improved success did not come at the cost of speed.
• Findings apply to patients without anticipated difficult airways in a supervised operating room setting.
Key Points
• Study type: randomized controlled trial.
• Operators: anesthesiology residents with limited clinical experience.
• Population: adult patients with normal airways undergoing RSI.
• Primary outcome: first-attempt intubation success.
• Main finding: videolaryngoscopy significantly outperformed direct laryngoscopy.
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