Comparison of the C-MAC Videolaryngoscope and Rigid Fiberscope with Direct Laryngoscopy in Easy and Difficult Airway Scenarios: A Manikin Study

J Emerg Med. 2016 Mar;50(3):e107-14. doi: 10.1016/j.jemermed.2015.06.070. Epub 2015 Dec 22.


Background: Intubation is a fundamental skill in maintaining adequate oxygenation and ventilation of seriously ill patients.

Objectives: To compare the C-MAC video laryngoscope and Bonfils intubation fiberscope with direct laryngoscopy in simulated easy and difficult airway scenarios.

Methods: This was a prospective, randomized-controlled cross-sectional study. Thirty emergency medicine residents attempted to intubate a manikin using four progressively more difficult airway settings (normal airway [scenario 1], cervical spine immobilization [scenario 2], cervical spine immobilization + tongue swelling scenario [scenario 3], and cervical spine immobilization + tongue swelling + limited jaw opening scenario [scenario 4]) with both the C-MAC video laryngoscope and the Bonfils intubation fiberscope and direct laryngoscope.

Results: In the first and the second scenarios, there were no statistically significant differences between the airway devices in terms of the duration of endotracheal intubation, the viewing duration of the glottic opening, and endotracheal tube insertion time. There was no statistically significant difference between the laryngoscopes in terms of the duration of endotracheal intubation and endotracheal tube insertion time in the third scenario. The overall success rates and the viewing duration of the glottic opening were shorter with the C-MAC and Bonfils in scenarios 3 and 4. Furthermore, the duration of intubation was better with Bonfils in scenario 4. The severity of dental trauma was lowest with the Bonfils in all scenarios. The device difficulty score was greatest with the Macintosh blade, except in the normal airway scenario. The most preferred airway device was the C-MAC.

Conclusion: The Bonfils and C-MAC enabled better visualization of the glottic opening when compared with the Macintosh laryngoscope.

Keywords: airway management; videolaryngoscope.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Airway Management / methods*
  • Cross-Sectional Studies
  • Humans
  • Intubation, Intratracheal / methods*
  • Laryngoscopes*
  • Laryngoscopy / instrumentation
  • Laryngoscopy / methods*
  • Manikins
  • Prospective Studies
  • Video Recording