title: Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study.
abstract: Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study.
  
  
  
  Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary.
  
  
  
  The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group.
  
  
  
  As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential "blind intubation" into an intubation under visual control.
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuerner
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Bastian
authors.initials: B
authors.lastname: Grande
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Piegeler
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlaepfer
authors.affiliation: Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
authors.affiliation: Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Hutcherson
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.affiliation: Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.|Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Kurt
authors.identifier: 0000-0003-0467-1736
authors.initials: K
authors.lastname: Ruetzler
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D007828:Laryngoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D008348:Manikins; D061646:Operative Time; D011897:Random Allocation; D020535:Video-Assisted Surgery / Q000379:methods* / Q000592:standards