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The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol.

ABSTRACT: Especially in the emergency setting, rapid and successful airway management is of major importance. Conventional endotracheal intubation is challenging and requires high level of individual skills and experience. Videolaryngoscopes like the C-MAC are likely to offer better glottis visualization and serve as alternatives to conventional endotracheal intubation. The aim of this study is to compare clinical performance and feasibility of the C-MAC videolaryngoscope compared to conventional endotracheal intubation in the emergency setting.This study is designed as a prospective, patient-blinded, mono-center, randomized cohort study. This study will be performed at the Emergency Department of the University Hospital Zurich, Zurich, Switzerland. All patients transferred to the Emergency Department and requiring emergent endotracheal intubation will be screened. Successful intubation with first intubation attempt will serve as the primary outcome. Time to intubation, intubation attempts, Cormack & Lehane Score, ease of intubation, complications, necessity of using alternate intubation device, maximum drop of saturation, and potential technical problems serve as secondary outcomes.In the clinical setting, the ultimate success rate of endotracheal intubation ranges between 97% and 99%. Unexpected difficulties during laryngoscopy and poor glottis visualization occur in up to 9% of all cases. In these cases, videolaryngoscopes may increase success rate of initial intubation attempt and thereby patient safety.www.clinicaltrials.gov (identifier NCT02297113 ).

SUBMITTER: Sulser S

PROVIDER: S-EPMC4407430 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol.

Sulser Simon S Ubmann Dirk D Brueesch Martin M Goliasch Georg G Seifert Burkhardt B Spahn Donat R DR Ruetzler Kurt K

Scandinavian journal of trauma, resuscitation and emergency medicine 20150424

<h4>Background</h4>Especially in the emergency setting, rapid and successful airway management is of major importance. Conventional endotracheal intubation is challenging and requires high level of individual skills and experience. Videolaryngoscopes like the C-MAC are likely to offer better glottis visualization and serve as alternatives to conventional endotracheal intubation. The aim of this study is to compare clinical performance and feasibility of the C-MAC videolaryngoscope compared to co ...[more]

PMID: 25903358

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Project description:Background/aimIncreased body mass index (BMI) and neck circumference are the two independent predictors of difficult intubation. McGrath MAC X-Blade is a videolaryngoscope specifically designed for difficult intubations.Materials and methodsEighty patients with the American Society of Anesthesiologists (ASA) physical status I–III undergoing elective surgery requiring endotracheal intubation were enrolled in the study. Patients were divided into two groups, nonobese (BMI < 30) and morbidly obese (BMI > 35). All patients were intubated with the McGrath MAC X-Blade in both groups. View optimization and tube insertion maneuvers such as reinsertion of the device, slight removal of the device, cricoid pressure, handling force, 90° anticlockwise rotation of the tube, use of stylet, and head flexion maneuvers were recorded. Cormack–Lehane grades, insertion times, intubation, and total intubation times were recorded. The hemodynamic changes and postoperative minor complications were also recorded.ResultsBody mass index, neck circumference, Mallampati scores, and ASA physical status were statistically higher in the morbidly obese group (P < 0.001 and P < 0.05). Sternomental distances were shorter in the morbidly obese (P < 0.05). Cormack–Lehane grades were comparable among the groups. The morbidly obese patients required more reinsertion attempts and cricoid pressure maneuvers during intubation than the nonobese patients (P = 0.019 versus P = 0.012, respectively). Slight removal of the device, handling force, use of the stylet, 90° anticlockwise rotation of the tube, and head flexion maneuvers were also helpful in both groups. Although device insertion times were similar between the groups, intubation and total intubation times were longer in the morbidly obese group (P = 0.009 and P = 0.034, respectively). The groups were comparable in hemodynamic changes and postoperative minor complications.ConclusionThe McGrath MAC X-Blade videolaryngoscope could safely be used both in nonobese (BMI < 30) and morbidly obese (BMI > 35) patients with the aid of some key maneuvers and with a statistically significant but clinically negligible prolongation of the intubation time.

Project description:BACKGROUND:Guidelines recommend endotracheal intubation in trauma patients with a Glasgow coma scale (GCS) < 9 because of the loss of airway reflexes and consequential risk of airway obstruction. However, in patients with acute alcohol intoxication guidelines are not clear. Thus, we aimed to determine the proportional incidence of intubation in alcohol intoxication and compare the clinical characteristics of intubated and non-intubated patients, as well as reasons for intubation in all patients and in the subgroup of patients with reduced GCS (< 9) but without traumatic brain injury. METHODS:We performed a retrospective analysis of all consultations to an urban ED in Switzerland that presented with an acute alcohol intoxication between 1st June 2012 and 31th Mai 2017. Patient and emergency consultations' characteristics, related injuries, intubation and reason for intubations were extracted. As a subgroup analysis, we analysed the patients with a GCS < 9 without a traumatic brain injury. RESULTS:Of 3003 consultations included from 01.06.2012 to 31.05.2017, 68 were intubated, leading to a proportional incidence of 2.3% intubations in alcohol-intoxication. Intubated patients had a lower blood alcohol concentration (1.3 g/kg [IQR 1.0-2.2] vs. 1.6 g/kg [IQR1.1-2.2], p = 0.034) and less often suffered from chronic alcohol abuse (1183 [39.4%] patients vs. 14 [20.6%], p = 0.001) than non-intubated patients. Patients with trauma were intubated more often (33 patients [48.5%] vs. 742 [25.3%], p < 0.001). In subgroup analysis, 110/145 patients (74.3%) were not intubated; again, more intubated patients had a history of trauma (9 patients [25.7%] vs. 10 [9.1%], p = 0.011). CONCLUSIONS:Intubation in alcohol-intoxicated patients is rare and, among intoxicated patients with GCS < 9, more than two thirds were not intubated in our study - without severe complications. Trauma in general, independent of the history of a traumatic brain injury, and a missing history of chronic alcohol abuse are associated with intubation, but not with blood alcohol concentration. Special caution is required for intoxicated patients with trauma or other additional intoxications or diseases.

Project description:OBJECTIVE:Video laryngoscopes are used for managing difficult airways. This study compared three video laryngoscopes' (Pentax-Airway Scope [Pentax], King Vision[King] and McGrath MAC [McGrath]) performances with the Macintosh direct laryngoscope (Macintosh) as emergency tracheal intubations (TIs) reference. DESIGN:Retrospective cohort study. SETTING:The emergency department (ED) and the intensive care unit (ICU) of two Japanese tertiary-level hospitals. PARTICIPANTS:All consecutive video-recorded emergency TI cases in EDs and ICUs between December 2013 and June 2015. PRIMARY OUTCOME MEASURES:The primary study endpoint was first-pass intubation success. A subgroup analysis examined the first-pass intubation success of expert versus non-expert operators. A logistic regression analysis was performed to identify the predictors of first-pass intubation success. RESULTS:A total of 287 emergency TIs were included. The first-pass intubation success rates were 78%, 58%, 78% and 58% for the Pentax, King, McGrath and Macintosh instruments, respectively (p=0.004, Fisher's exact test). The non-expert operators' success rates were significantly higher (p=0.00004, Fisher's exact test) for the Pentax (87%) and McGrath (78%) instruments than that for the King (50%) and Macintosh (46%) instruments, unlike that of the experts (67%, 67%, 78% and 78% for Pentax, McGrath, King and Macintosh, respectively; p=0.556, Fisher's exact test). After TI indication, difficult airway characteristics, and expert versus non-expert operator parameters adjustments, the Pentax (OR=3.422, 95% CI 1.551 to 7.550; p=0.002) and McGrath (OR= 3.758, CI 1.640 to 8.612; p=0.002) instruments showed significantly higher first-pass intubation success odds when compared with the Macintosh laryngoscope (reference, OR=1). The King instrument, however, (OR=1.056; 95% CI 0.487 to 2.289, p=0.889) failed to show any significant superiority. CONCLUSION:The Pentax and McGrath laryngoscopes showed significantly higher emergency TI first-pass intubation success rates than the King laryngoscope when compared with the Macintosh laryngoscope, especially for non-expert operators. TRIAL REGISTRATION NUMBER:UMIN000027925; Results.

Dataset Information

The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol.

Publications

The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol.

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