Document Detail

Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway.
MedLine Citation:
PMID:  22261795     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Video laryngoscopy may be useful in the setting of the difficult airway, but it remains unclear if intubation success is improved in routine difficult airway management. This study compared success rates for tracheal intubation with the C-MAC® video laryngoscope (Karl Storz, Tuttlingen, Germany) with conventional direct laryngoscopy in patients with predicted difficult airway.
METHODS: We conducted a two arm, single-blinded randomized controlled trial that involved 300 patients. Inclusion required at least one of four predictors of difficult intubation. The primary outcome was successful tracheal intubation on first attempt.
RESULTS: The use of video laryngoscopy resulted in more successful intubations on first attempt (138/149; 93%) as compared with direct laryngoscopy (124/147; 84%), P = 0.026. Cormack-Lehane laryngeal view was graded I or II in 139/149 of C-MAC attempts versus 119/147 in direct laryngoscopy attempts (P < 0.01). Laryngoscopy time averaged 46 s (95% CI, 40-51) for the C-MAC group and was shorter in the direct laryngoscopy group, 33 s (95% CI, 29-36), P < 0.001. The use of a gum-elastic bougie and/or external laryngeal manipulation were required less often in the C-MAC intubations (24%, 33/138) compared with direct laryngoscopy (37%, 46/124, P = 0.020). The incidence of complications was not significantly different between the C-MAC (20%, 27/138) versus direct laryngoscopy (13%, 16/124, P = 0.146).
CONCLUSION: A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.
Michael F Aziz; Dawn Dillman; Rongwei Fu; Ansgar M Brambrink
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  116     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-23     Completed Date:  2012-04-10     Revised Date:  2012-11-13    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  629-36     Citation Subset:  AIM; IM    
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA.
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MeSH Terms
Airway Management / instrumentation,  methods*
Intubation, Intratracheal / instrumentation,  methods*
Laryngoscopy / instrumentation,  methods*
Middle Aged
Single-Blind Method
Treatment Outcome
Video Recording / instrumentation,  methods*
Comment In:
Anesthesiology. 2012 Mar;116(3):515-7   [PMID:  22261794 ]
Anesthesiology. 2012 Oct;117(4):912-3; author reply 913-4   [PMID:  22990184 ]
Anesthesiology. 2012 Oct;117(4):911-2; author reply 913-4   [PMID:  22990183 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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