23 Comparison of the C-MAC and GlideScope-Mac for Intubation in the Emergency Department

To determine the first pass success (FPS) of the C-MAC and GlideScope-Mac (GVL-MAC) when used for video laryngoscopy (VL) and direct laryngoscopy (DL) in the emergency department (ED). Continuous quality improvement (CQI) data were prospectively collected on all patients intubated in the ED from July 1, 2014 to March 31, 2016, the time period when both devices were available in the ED. Following each intubation the operator completed a standardized data form which included information on patient, operator, and intubation characteristics. Operators also documented how the device was used, with one of four options: DL only, VL only, DL to VL switch (during attempt), or VL to DL switch (during attempt). All adult patients (≥18 years) undergoing RSI by an EM resident using either the C-MAC or GVL-MAC were included in the analysis. The primary outcome was first-pass success (FPS), defined as successful tracheal intubation on a single insertion of the laryngoscope blade. In the case of intubations started as DL, switch to video assist during the first attempt was considered a failed DL attempt. Over the 21-month study period, 318 adult patients underwent RSI by an EM resident in the ED using either C-MAC or GVL-MAC. The C-MAC was used on 133 patients and the GVL-MAC was used on 185 patients. See table for first pass success with each device. When used as a VL, the C-MAC and GVL-MAC resulted in similar FPS. However, when used as a DL, the C-MAC resulted in a higher FPS than the GVL-MAC. Though further investigation is warranted, these results suggest that the C-MAC functions superiorly to the GVL-MAC as a DL.Tabled 1First Pass Success by Device and TechniqueDevice and TechniqueFirst Pass Success95% CIC-MAC as VL93.4% (71/76)85.3%-97.8%GVL-MAC as VL92.3% (96/104)85.4%-96.6%C-MAC as DL64.9% (37/57)51.1%-77.1%GVL-MAC as DL43.2% (35/81)32.2%-54.7% Open table in a new tab