title: The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department.
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.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Jarrod M
authors.initials: JM
authors.lastname: Mosier
authors.affiliation: Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona.
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: John M
authors.initials: JM
authors.lastname: Dicken
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Leah
authors.initials: L
authors.lastname: Kalin
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Parisa P
authors.initials: PP
authors.lastname: Javedani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D017211:Treatment Failure; D055815:Young Adult
keywords: Emergency Intubation; Failed Intubation; Rescue Intubation; Video Laryngoscopy