Friday 23 August 2019

C-MAC vs Direct Laryngoscopy for Rapid Sequence Intubation in the ED

Prior studies have clearly proven a video laryngoscopes (VL) generally provide a better view of the chords. But does this translate into improved first pass success rates of intubation?

This study tried to determine which is ultimately better; a C-MAC or old fashion direct laryngoscopy (DL)? This is probably a decent research question.

150 ED patients undergoing RSI in a single ED in Zurich were randomised to either C-MAC vs. DL.  

For "ethical reasons" they excluded patients that they thought would be difficult to intubate. The primary outcome measure was first pass success rate. It was powered to find a 14% difference between the groups.

Unfortunately, all intubations were performed by one of three “very experienced” anaesthetic consultants.

Can you guess the first pass success rate for “very experienced” anaesthetists for simple intubations?

Yes, you guessed it… 100% in both groups. (Well, just about.)

This study was never going to find a difference and I wonder why they went to so much effort in the first place. Seems like it was always going to be a waste of time.

We already know that video laryngoscopes are taking over. But what do you do when the scope fails, unavailable, or needs rescue?

Learn both.


Sulser S, Ubmann D, Schlaepfer, et al. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department. Eur J Anaesthesiol 2016;33:1-6. [link to article]

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