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

The primary objective of this randomised trial was to compare the first-attempt intubation success rate between the C-MAC videolaryngoscope (VL) and the Macintosh direct laryngoscope (DL) when used by novice anaesthesia residents during rapid sequence induction (RSI). Secondary objectives were to compare intubation time; laryngoscopic view (Cormack-Lehane grade (CLG) and Percentage of Glottic Opening (POGO) score); the need for adjunct manoeuvres and devices (optimal external laryngeal manipulation (OELM), release of cricoid pressure, and use of a gum elastic bougie (GEB)); and the incidence of hypoxia, regurgitation, mucosal or dental injury, and haemodynamic changes during and after intubation.

This randomised controlled trial included 172 adult patients with normal airways requiring RSI, who were allocated to either the VL group (n = 86) or the DL group (n = 86). Resident anaesthesiologists underwent lecture- and simulation-based training prior to performing intubations in the operating room. RSI and tracheal intubation were performed using the allocated device. The primary endpoint was first-attempt intubation success. Secondary endpoints included intubation time, manoeuvres required for successful intubation, incidence of hypoxia and regurgitation, mucosal or dental injury, and haemodynamic changes during and after intubation.

First-attempt intubation success was significantly higher in the VL group compared with the DL group (93% vs 67%, P < 0.001). A CLG 1 view was obtained in 76% of patients in the VL group and 54% in the DL group (P < 0.001). External laryngeal manipulation, release of cricoid pressure, use of a GEB, and dental injuries were significantly lower in the VL group (P < 0.001). Heart rate and systolic blood pressure increased significantly during DL-guided intubation.

VL-guided intubation by novice anaesthesia residents during RSI was associated with a higher first-attempt success rate and superior laryngoscopic views compared with DL, along with fewer adjunct manoeuvres and airway injuries. These findings support the use of VL as a valuable tool for resident-performed RSI in patients without anticipated difficult airways.