The Utility of the C-MAC as a Direct Laryngoscope for Intubation in the Emergency Department

J Emerg Med. 2016 Oct;51(4):349-357. doi: 10.1016/j.jemermed.2016.05.039. Epub 2016 Jul 25.


Background: Although the C-MAC (Karl Storz, Tuttlingen, Germany) is a video laryngoscope (VL), it can also be used as a direct laryngoscope (DL).

Objective: The goal of this study was to evaluate the utility of the C-MAC as a DL for intubations in the emergency department (ED).

Methods: This was an analysis of prospectively collected continuous quality-improvement data during the 6-year period from February 1, 2009 to January 31, 2015, when both the C-MAC and Macintosh DL (Mac DL) were clinically available in our ED. This analysis included adult patients who underwent rapid sequence intubation by an emergency medicine resident in the ED with a C-MAC initially used as a DL or a Mac DL. The primary outcome measure was the first pass success (FPS).

Results: When the C-MAC was used as a DL, the initial DL attempt was successful in 199 of 346 (57.6%) cases. When the attempt could not be completed using the C-MAC as a DL, the operator utilized the video monitor and successfully completed the intubation using VL in 104 of 134 (77.6%) cases, thus achieving an overall FPS of 303 of 346 (87.6%). When the Mac DL was used, the FPS was 505 of 671 (75.3%).

Conclusions: The C-MAC is a useful device for DL because in the event of a failed DL attempt, operators have the option of switching to the video monitor to successfully complete the intubation using VL without having to make a second attempt.

Keywords: C-MAC; EM resident intubations; direct laryngoscopy.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypoxia / etiology
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / instrumentation*
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / standards
  • Laryngoscopes*
  • Laryngoscopy / adverse effects
  • Laryngoscopy / instrumentation*
  • Larynx / diagnostic imaging
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prospective Studies