First-Attempt Intubation Success Rate Using the C-MAC Videolaryngoscope Versus Direct Laryngoscopy Among...

Area of Science:

• Anesthesiology
• Medical Devices
• Airway Management

Background:

• Direct laryngoscopy (DL) is a standard technique for tracheal intubation.
• Videolaryngoscopy (VL) offers a potentially improved view for intubation.
• Novice resident performance with VL versus DL during rapid sequence induction (RSI) requires evaluation.

Purpose of the Study:

• To compare the first-attempt intubation success rate of C-MAC videolaryngoscope (VL) versus Macintosh direct laryngoscope (DL) in novice anesthesia residents during RSI.
• To assess secondary outcomes including intubation time, laryngoscopic view, need for adjunct maneuvers, and incidence of adverse events.

Main Methods:

• A randomized controlled trial involving 172 adult patients requiring RSI.
• Patients were allocated to either the VL group (n=86) or DL group (n=86).
• Anesthesiology residents received standardized training before performing intubations.

Main Results:

• First-attempt intubation success was significantly higher with VL (93%) compared to DL (67%) (P < 0.001).
• Superior laryngoscopic views (Cormack-Lehane grade 1) were more frequent with VL (76%) than DL (54%) (P < 0.001).
• VL use was associated with significantly fewer adjunct maneuvers, less cricoid pressure release, and fewer dental injuries.

Conclusions:

• Videolaryngoscopy (VL) by novice residents during RSI demonstrates a higher first-attempt success rate and better visualization than direct laryngoscopy (DL).
• VL is associated with fewer required adjunct maneuvers and airway injuries.
• VL is a valuable tool for resident-performed RSI in patients without anticipated difficult airways.