C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial.
BACKGROUND
The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions.


METHODS
The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with <5years of medical experience participated in the study. The paramedics attempted to intubate manikins in 3 airway scenarios: normal airway without cervical immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C).


RESULTS
Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (p<0.05) for the time of intubation (23 s MAC vs. 19 s C-MAC), success of the first intubation attempt (88.6% MAC vs. 100% C-MAC), Cormack-Lehane grade, POGO score, severity of dental compression, device difficulty score, and preferred airway device. Scenario C: The results with C-MAC were significantly better than those with MAC (p<0.05) for all the analysed variables: success of the first attempt (51.4% MAC vs. 100% C-MAC), overall success rate, intubation time (27 s MAC vs. 20.5 s C-MAC), Cormack-Lehane grade, POGO score, dental compression, device difficulty score and the preferred airway device.


CONCLUSIONS
The C-MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
Jacek
J
Smereka
Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland.
Jerzy R
JR
Ladny
Outcomes Research Consortium, Cleveland, USA.
Amanda
A
Naylor
Department of Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anaesthesiology, Anaesthesiology Institute, Cleveland Clinic, Cleveland, USA. Electronic address: kurt.ruetzler@reflex.at.
Kurt
K
Ruetzler
Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
Lukasz
L
Szarpak
D000328:Adult; D058109:Airway Management / Q000295:instrumentation; D000488:Allied Health Personnel / Q000193:education*; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods*; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008348:Manikins; D056888:Patient Positioning; D011446:Prospective Studies; D011897:Random Allocation
C-MAC; Cervical spine immobilization; Difficult airway; Intubation