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The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department.
J Emerg Med 2015; 48(3):280-6JE

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.

Authors+Show Affiliations

Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona.Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.Department of Medicine, Oregon Health and Science University, Portland, Oregon.Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25498851

Citation

Sakles, John C., et al. "The C-MAC® Video Laryngoscope Is Superior to the Direct Laryngoscope for the Rescue of Failed First-attempt Intubations in the Emergency Department." The Journal of Emergency Medicine, vol. 48, no. 3, 2015, pp. 280-6.
Sakles JC, Mosier JM, Patanwala AE, et al. The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. J Emerg Med. 2015;48(3):280-6.
Sakles, J. C., Mosier, J. M., Patanwala, A. E., Dicken, J. M., Kalin, L., & Javedani, P. P. (2015). The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. The Journal of Emergency Medicine, 48(3), pp. 280-6. doi:10.1016/j.jemermed.2014.10.007.
Sakles JC, et al. The C-MAC® Video Laryngoscope Is Superior to the Direct Laryngoscope for the Rescue of Failed First-attempt Intubations in the Emergency Department. J Emerg Med. 2015;48(3):280-6. PubMed PMID: 25498851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. AU - Sakles,John C, AU - Mosier,Jarrod M, AU - Patanwala,Asad E, AU - Dicken,John M, AU - Kalin,Leah, AU - Javedani,Parisa P, Y1 - 2014/12/12/ PY - 2014/08/01/received PY - 2014/10/04/revised PY - 2014/10/08/accepted PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2016/1/1/medline KW - Emergency Intubation KW - Failed Intubation KW - Rescue Intubation KW - Video Laryngoscopy SP - 280 EP - 6 JF - The Journal of emergency medicine JO - J Emerg Med VL - 48 IS - 3 N2 - 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. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/25498851/The_C_MAC®_video_laryngoscope_is_superior_to_the_direct_laryngoscope_for_the_rescue_of_failed_first_attempt_intubations_in_the_emergency_department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(14)01124-X DB - PRIME DP - Unbound Medicine ER -