title: The C-MAC videolaryngoscope for prehospital emergency intubation: a prospective, multicentre, observational study.
abstract: BACKGROUND
  In this preliminary prospective observational study at four physician-led air rescue centres, the efficacy of the C-MAC (Karl Storz, Tuttlingen, Germany), a new portable videolaryngoscope, was evaluated during prehospital emergency endotracheal intubations.
  
  
  METHODS
  80 consecutive patients requiring prehospital emergency intubation, treated by a physician introduced in the use of the C-MAC were enrolled in this study.
  
  
  RESULTS
  Indication for prehospital intubation was trauma in 45 cases (including maxillo-facial trauma in 10 cases), cardiopulmonary resuscitation in 14 cases, and unconsciousness of neurological aetiology and cardiogenic dyspnoea in 21 cases. Forty-nine patients were intubated with a C-MAC blade size 3, and 31 with a C-MAC blade size 4. Median time to successful intubation was 20 (min-max: 5-300) seconds; 63 patients were intubated on the first attempt, 13 on the second and four after more than two attempts. A Cormack-Lehane class 1 view of the glottis was seen in 46 patients, class 2a view in 21, class 2b in eight, class 3 in three and class 4 in two. Six patients could not be intubated with the videolaryngoscopic view, but were successfully intubated at the same attempt using the C-MAC with the direct laryngoscopic view.
  
  
  CONCLUSIONS
  The C-MAC videolaryngoscope was suitable for prehospital emergency endotracheal intubations with complicated airway conditions, such as maxillo-facial trauma. The option to perform direct laryngoscopy and videolaryngoscopy with the same device appears to be exceptionally important in the prehospital setting.
authors.affiliation: University Hospital Schleswig-Holstein, Campus Kiel, Department of Anaesthesiology and Intensive Care Medicine, Schwanenweg 21, D-24105 Kiel, Germany. cavus@anaesthesie.uni-kiel.de
authors.forename: Erol
authors.initials: E
authors.lastname: Cavus
authors.forename: Andreas
authors.initials: A
authors.lastname: Callies
authors.forename: Volker
authors.initials: V
authors.lastname: Doerges
authors.forename: Gilbert
authors.initials: G
authors.lastname: Heller
authors.forename: Sabine
authors.initials: S
authors.lastname: Merz
authors.forename: Peter
authors.initials: P
authors.lastname: Rösch
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Matthias
authors.initials: M
authors.lastname: Helm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002648:Child; D005260:Female; D005858:Germany; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D020704:Laryngoscopes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014741:Video Recording / Q000592:standards; D055815:Young Adult