The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department

John C. Sakles, Jarrod M. Mosier, Asad E Patanwala, John M. Dicken, Leah Kalin, Parisa P. Javedani

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective To compare the effectiveness of the C-MAC® video laryngoscope (CMAC) to the direct laryngoscope (DL) when used to rescue a failed first attempt intubation in the emergency department (ED). Methods Data were prospectively collected on all patients intubated in an academic ED center over a five-year period from February 1, 2009 to January 31, 2014 when both the CMAC and the DL were available. Following each intubation the operator completed a continuous quality improvement (CQI) form documenting patient, operator and intubation characteristics. All orotracheal intubations attempted by emergency physicians (EPs) on adult patients with a failed first intubation attempt, and in which the CMAC or the DL was used for the second attempt, were included. The primary outcome was successful intubation on the second attempt using either the CMAC or the DL. A multivariate logistic regression analysis was performed to adjust for potential confounders. Results During the five-year study period, there were 460 adult orotracheal intubation attempts by EPs which were not successful on the first attempt. In 398 (86.5%) of these cases the same operator performed the second attempt. The CMAC was utilized for the second attempt in 141 cases and was successful in 116 (82.3%; 95% CI 75.0%-88.2%) and the DL was utilized in 94 cases and was successful in 58 (61.7%; 95% CI 51.1%-71.5%). In a multivariate logistic regression analysis the CMAC was associated with an increased odds (adjusted OR 3.5; 95% CI 1.9-6.7) of a second attempt success compared to the DL. Conclusions After a failed first intubation attempt in the ED, regardless of the initial device used, the CMAC was more successful than the DL when used for the second attempt. This suggests that the CMAC is the preferred rescue device after an initial intubation attempt in the ED fails.

Original languageEnglish (US)
Pages (from-to)280-286
Number of pages7
JournalJournal of Emergency Medicine
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2015

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Laryngoscopes
Intubation
Hospital Emergency Service
Emergencies
Logistic Models
Regression Analysis
Physicians
Equipment and Supplies
Quality Improvement

Keywords

  • Emergency Intubation
  • Failed Intubation
  • Rescue Intubation
  • Video Laryngoscopy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. / Sakles, John C.; Mosier, Jarrod M.; Patanwala, Asad E; Dicken, John M.; Kalin, Leah; Javedani, Parisa P.

In: Journal of Emergency Medicine, Vol. 48, No. 3, 01.03.2015, p. 280-286.

Research output: Contribution to journalArticle

Sakles, John C. ; Mosier, Jarrod M. ; Patanwala, Asad E ; Dicken, John M. ; Kalin, Leah ; Javedani, Parisa P. / The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. In: Journal of Emergency Medicine. 2015 ; Vol. 48, No. 3. pp. 280-286.
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abstract = "Objective To compare the effectiveness of the C-MAC{\circledR} video laryngoscope (CMAC) to the direct laryngoscope (DL) when used to rescue a failed first attempt intubation in the emergency department (ED). Methods Data were prospectively collected on all patients intubated in an academic ED center over a five-year period from February 1, 2009 to January 31, 2014 when both the CMAC and the DL were available. Following each intubation the operator completed a continuous quality improvement (CQI) form documenting patient, operator and intubation characteristics. All orotracheal intubations attempted by emergency physicians (EPs) on adult patients with a failed first intubation attempt, and in which the CMAC or the DL was used for the second attempt, were included. The primary outcome was successful intubation on the second attempt using either the CMAC or the DL. A multivariate logistic regression analysis was performed to adjust for potential confounders. Results During the five-year study period, there were 460 adult orotracheal intubation attempts by EPs which were not successful on the first attempt. In 398 (86.5{\%}) of these cases the same operator performed the second attempt. The CMAC was utilized for the second attempt in 141 cases and was successful in 116 (82.3{\%}; 95{\%} CI 75.0{\%}-88.2{\%}) and the DL was utilized in 94 cases and was successful in 58 (61.7{\%}; 95{\%} CI 51.1{\%}-71.5{\%}). In a multivariate logistic regression analysis the CMAC was associated with an increased odds (adjusted OR 3.5; 95{\%} CI 1.9-6.7) of a second attempt success compared to the DL. Conclusions After a failed first intubation attempt in the ED, regardless of the initial device used, the CMAC was more successful than the DL when used for the second attempt. This suggests that the CMAC is the preferred rescue device after an initial intubation attempt in the ED fails.",
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AB - Objective To compare the effectiveness of the C-MAC® video laryngoscope (CMAC) to the direct laryngoscope (DL) when used to rescue a failed first attempt intubation in the emergency department (ED). Methods Data were prospectively collected on all patients intubated in an academic ED center over a five-year period from February 1, 2009 to January 31, 2014 when both the CMAC and the DL were available. Following each intubation the operator completed a continuous quality improvement (CQI) form documenting patient, operator and intubation characteristics. All orotracheal intubations attempted by emergency physicians (EPs) on adult patients with a failed first intubation attempt, and in which the CMAC or the DL was used for the second attempt, were included. The primary outcome was successful intubation on the second attempt using either the CMAC or the DL. A multivariate logistic regression analysis was performed to adjust for potential confounders. Results During the five-year study period, there were 460 adult orotracheal intubation attempts by EPs which were not successful on the first attempt. In 398 (86.5%) of these cases the same operator performed the second attempt. The CMAC was utilized for the second attempt in 141 cases and was successful in 116 (82.3%; 95% CI 75.0%-88.2%) and the DL was utilized in 94 cases and was successful in 58 (61.7%; 95% CI 51.1%-71.5%). In a multivariate logistic regression analysis the CMAC was associated with an increased odds (adjusted OR 3.5; 95% CI 1.9-6.7) of a second attempt success compared to the DL. Conclusions After a failed first intubation attempt in the ED, regardless of the initial device used, the CMAC was more successful than the DL when used for the second attempt. This suggests that the CMAC is the preferred rescue device after an initial intubation attempt in the ED fails.

KW - Emergency Intubation

KW - Failed Intubation

KW - Rescue Intubation

KW - Video Laryngoscopy

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