Randomized controlled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways

Abstract

Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anaesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed videolaryngoscopes are available. This randomized controlled study aims to compare the use of the McGrath videolaryngoscope with the C-MAC videolaryngoscope in adult patients with potential difficult airways. A total of 130 patients with the Mallampati grade of ≥3, requiring orotracheal intubation, were randomized to either having intubation with the McGrath videolaryngoscope or the C-MAC videolaryngoscope. The primary outcome was time to intubation. The laryngoscopic view, the number of intubation attempts, the proportion of intubation success, the ease of intubation, the haemodynamic responses to intubation, and the incidence of any complications were also recorded. Time to successful intubation with the C-MAC videolaryngoscope was shorter when compared with the McGrath videolaryngoscope {50 s [inter-quartile range (IQR) 38-70] vs 67 s (IQR 49-108), P<0.001}, despite the McGrath videolaryngoscope providing significantly more grade 1 laryngoscopic views. The C-MAC videolaryngoscope also resulted in significantly fewer intubation attempts and greater ease of intubation when compared with the McGrath videolaryngoscope. There were no statistically significant differences in the proportion of intubation success, the number of complications, and the changes in haemodynamic responses between the two videolaryngoscopes. The C-MAC videolaryngoscope allowed a quicker intubation time, fewer intubation attempts, and greater ease of intubation compared with the McGrath videolaryngoscope when used in patients with the Mallampati grade of ≥3.