Abstract
BackgroundWe tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the disposable i-view™ video laryngoscope (i-view) with an integrated display or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.MethodsIn this randomized, crossover manikin study, we recruited 37 medical personnel with > 2 years of dedicated anesthesia experience from five hospitals. After the three successful intubations within 60 s using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least 2-h intervals in a determined order. The primary outcome was the intubation time. The secondary outcomes were success rate, Cormack-Lehane grade, and subjective difficulty scale score.ResultsThirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P = 0.247). The success rate was 95–100%, without a significant difference (P = 0.135). The i-view and C-MAC exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh; however, there were no differences between the i-view and C-MAC.ConclusionsRapid and highly successful tracheal intubation was possible with both Macintosh, i-view, and C-MAC on a normal airway manikin in an aerosol box. Improved Cormack-Lehane grade and the ease of performing the procedure may support the use of video laryngoscopes.Trial registrationUMIN Clinical Trials Registry, UMIN000040269. Registered 30 April 2020.
Highlights
We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the disposable i-viewTM video laryngoscope (i-view) with an integrated display or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box
The success rate was 95–100% without a significant difference, with two failed attempts with the i-view
There were no differences in the Cormack-Lehane grade and the subjective difficulty scale score between i-view and C-MAC
Summary
We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the disposable i-viewTM video laryngoscope (i-view) with an integrated display or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box. The “aerosol box” was first conceived by a Taiwanese doctor and was reported effective in preventing widespread dispersion of cough droplets during tracheal intubation [10,11,12]. This box was expected to be useful in situations where higher-level personal protective equipment (PPE), such as the medical protective head hood and powered air-purifying respirator, is unavailable [13, 14]. Many patients with COVID-19 who are undergoing tracheal intubation are hypoxemic and require rapid, highly successful procedures; it is essential to identify the optimal device to use with the box [2, 7]
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