Usefulness of C-MAC video laryngoscope in direct laryngoscopy training in the emergency department: A propensity score matching analysis

PLoS One. 2018 Dec 12;13(12):e0208077. doi: 10.1371/journal.pone.0208077. eCollection 2018.


Objectives: We determined the usefulness of C-MAC video laryngoscope (C-MAC) as a safe training tool for the direct laryngoscopy technique in the emergency department.

Methods: We retrospectively analyzed an institutional airway registry of adult (≥18 years old) patients from April 2014 through October 2016. In this study, the operator used C-MAC as a direct laryngoscope (DL) with limited access to the screen, and the supervisor instructed the operator via verbal feedback while watching the screen. Patients were categorized into the DL group if a conventional DL was used and the C-DL group if a C-MAC used as a DL.

Results: Of 744 endotracheal intubations, 163 propensity score-matched pairs were generated (1-to-n matching: C-DL group, 163 vs. DL group, 428). For the propensity-matched groups, the overall first pass success rate was 69%, while those in the C-DL and DL groups were 79% and 65%, respectively. Overall, multiple attempts were required in 8% of patients, with 4% in the C-DL group and 9% in the DL group. The overall complication rate was 11%, with 4% in the C-DL group and 14% in the DL group. In multivariable analysis, the adjusted odds ratios of C-DL use for first pass success, multiple attempts, and complications were 2.05 (95% confidence interval [CI] 1.18-2.87, p < 0.01), 0.38 (95% CI 0.15-0.94; p < 0.01), and 0.28 (95% CI 0.12-0.63; p < 0.01), respectively.

Conclusions: Our study suggests that the C-MAC could be useful for training residents in the direct laryngoscopy while ensuring patient safety in the emergency department.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Internship and Residency*
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / instrumentation*
  • Laryngoscopes / adverse effects*
  • Laryngoscopy / adverse effects
  • Laryngoscopy / education*
  • Laryngoscopy / instrumentation
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Safety / statistics & numerical data*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Propensity Score
  • Retrospective Studies

Grant support

The authors received no specific funding for this work.