Current evidence of the use of C-MAC video laryngoscopes in adult airways | Customer Relationship Management

2021-12-15 00:24:51 By : Mr. LOD SHOCK

Javascript is currently disabled in your browser. When javascript is disabled, some functions of this website will not work.

Open access for scientific and medical research

From submission to the first editing decision.

From editor acceptance to publication.

The above percentage of manuscripts have been rejected in the past 12 months.

Open access to peer-reviewed scientific and medical journals.

Dove Medical Press is a member of OAI.

Batch reprints for the pharmaceutical industry.

We provide real benefits for authors, including fast processing of papers.

Register your specific details and specific drugs of interest, and we will match the information you provide with articles in our extensive database and send you a PDF copy via email in a timely manner.

Back to Journal »Treatment and Clinical Risk Management» Volume 13

Author: Xue FS, Li HX, Liu YY, Yang GZ

Published on July 3, 2017, Volume 2017: 13 pages, 831-841 pages

DOI https://doi.org/10.2147/TCRM.S136221

Single anonymous peer review

Reviewing editor: Professor Wang Deyun

Fu-Shan Xue, Hui-Xian Li, Ya-Yang Liu, Gui-Zhen Yang, Department of Anesthesiology, Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital Abstract: C-MAC video laryngoscope is the first Macintosh video laryngoscope . Since its original version of the video Macintosh system came out in 1999, the device has been modified many times. A unique feature of the C-MAC device is that it can provide 2 options of direct and video laryngoscopy through the same device. Existing evidence shows that in patients with normal airways, compared with direct laryngoscopy, C-MAC video laryngoscope can provide equivalent or better views of the larynx and exert less force on the maxillary incisors, but It did not provide decisive benefits in terms of intubation time, intubation success rate, and quantity. Intubation attempts, the use of auxiliary equipment, and the hemodynamic response to intubation were not provided. For patients with predicted or known difficult airways, compared with direct laryngoscopy, C-MAC video laryngoscope can obtain better laryngeal vision, higher intubation success rate and shorter intubation time. In addition, the option of using the same device to perform direct and video laryngoscopes makes C-MAC video laryngoscopes particularly suitable for emergency intubation. In addition, C-MAC video laryngoscope is a very good tool in the teaching of tracheal intubation. However, the use of C-MAC video laryngoscope for tracheal intubation may sometimes fail. The introduction of C-MAC video laryngoscope in clinical practice must be accompanied by a formal training program for normal and difficult airway management. Keywords: visual laryngoscope, direct laryngoscope, airway management, tracheal intubation, patient safety

In the past ten years, video laryngoscopy assisted endotracheal intubation has been widely used in airway management due to its several significant advantages. These include: 1) Improve the visualization of the larynx without aligning the 3 airway axes, especially in difficult airway conditions. 1 2) High-quality, enlarged airway images can easily identify airway anatomy and abnormalities, and help operate airway equipment. 2 3) The entire team can see the laryngoscope and intubation process on the monitor, not just the intubator. This multi-person visualization function can promote team communication and cohesion, improve the coordination between the intubator and the assistant, and thus change the difficult airway management from "me" to "us". 3,4 In addition, the ability of the video laryngoscope provides a shared view that can be used for endotracheal intubation teaching. 5

There are many video laryngoscopes available, and the number is increasing, and many existing equipment are constantly improving. Depending on the situation that the clinician must manage, the function of each device may provide advantages or disadvantages. 6 Among these devices, a video laryngoscope with a Macintosh blade can provide the unique advantages of direct and indirect laryngoscopy in a single intubation attempt. A typical example of this type of equipment is the C-MAC video laryngoscope, which was the first Macintosh-type video laryngoscope and has a large number of publications. This review aims to describe the characteristics of the C-MAC video laryngoscope based on the literature published in peer-reviewed journals, and summarize the evidence of the effectiveness of the device in adult airway management and its role in the teaching of tracheal intubation.

C-MAC video laryngoscope was developed and manufactured by Karl Storz GmbH & Co. KG (Tuttlingen, Germany) in 1999. The video Macintosh system in the original model was operated by a small color camera mounted on the handle of a traditional laryngoscope. A Macintosh blade is attached to the handle, and a combined image/beam passes through a small metal tube, recessed 40 mm from the tip of the blade. The camera cable is connected to the control unit, and the optical cable is connected to the light source. The video Macintosh system is mounted on a cart for easy movement of the device. The cart supports an 8-inch display mounted on the swivel arm on the left side of the patient (Figure 1). 7,8

Figure 1 Video Macintosh system. Note: (A) The Macintosh blade is attached to the handle, and a combined image/beam passes through a small metal tube, recessed 40 mm from the tip of the blade. (B) Set up a video Macintosh system and hang a cart with an 8-inch monitor. Copyright © KARL STORZ GmbH & Co. KG Germany.80

The modified version of the video Macintosh system is the Storz direct coupling interface, Berci-Kaplan or V-MAC video laryngoscope, which consists of a laryngoscope, a large 8-inch display, a light source and a camera control unit. 5 The fiber optic light power cord and camera cable appear from the top of the handle (Figure 2A), and they are connected to the light source and camera control unit respectively.

Figure 2 C-MAC video laryngoscope system. Note: (A) Storz Berci-Kaplan DCI® video laryngoscope (V-MAC video laryngoscope); (B) Storz C-MAC video laryngoscope; (C) portable C-MAC video laryngoscope with 2 attached to the handle Inch pocket monitor; (D) The latest C-MAC handle, with lightweight and multifunctional interface. Copyright © KARL STORZ GmbH & Co. KG Germany.80

C-MAC or Boedeker–Dörges video laryngoscope is an improvement of V-MAC equipment. It includes an electronic module using semiconductor chip technology and consists of only 3 parts: a laryngoscope, an electronic module, and a separate 7-inch (18 cm) monitor (Figure 2B). The monitor is connected to the electronic module inserted into the laryngoscope. The weight of a battery-equipped display is approximately 1 kg. The key innovation of the C-MAC device is a fully portable setup with improved image quality. The main difference between C-MAC and V-MAC devices is that the C-MAC video laryngoscope includes improved optical components, field of view, interfaces for adjusting video quality, and easy-to-record images. In addition, the manufacturer provided the C-MAC device with a 2-inch pocket monitor attached to the handle (Figure 2C). This portable device is specially developed for pre-hospital and in-hospital first aid. The device uses lithium-ion battery technology with a capacity of at least 2 hours, and the pocket monitor can display clear images under strong light. 1,6-9

C-MAC devices can create continuous video recordings or still pictures on a removable secure digital card. 8 The electronic module includes 2 buttons for photo and video capture. In addition, the image of the C-MAC device can also be displayed on other devices or recorded through the standard video output port.

There are 3 C-MAC reusable metal Macintosh blades (No. 2-4) for adult patients. 6 The reusable blade adopts a closed design, there is no gap between sanitary traps, and the edge is inclined to avoid tissue damage. The 10 C proximal flange-MAC reusable blade is significantly larger than the blades of the Glidescope and McGrath video laryngoscopes, with a base height of about 2.5 cm, while the Glidescope video laryngoscope is 1.5 cm and the McGrath video laryngoscope is 1.25 cm. This provides more space for operating the tracheal tube with the C-MAC device. In addition, compared with Glidescope or McGrath video laryngoscope, the proximal shape and size of the C-MAC reusable blade makes the duct to the glottis more direct. However, the disadvantage of the larger proximal flange of the C-MAC video laryngoscope may be that it requires a larger opening compared to the smaller video laryngoscope with fangs. 11

The tip of the C-MAC reusable blade contains a 320×240 pixel complementary metal oxide semiconductor video chip and an anti-fog lens. A camera with a light source is located near the tip of the blade and has a viewing angle of 80°, allowing wide viewing angles and high-resolution color images of the tip of the blade to be displayed on the monitor. 8 Because the obtained view by C-MAC device includes the blade tip (Figure 2B), it allows visually guiding the blade tip into the epiglottic valley. 10 Reusable blades need to be sterilized between each patient.

Recently, manufacturers have modified the relatively large and bulky handles of C-MAC devices. The new handle is cut off and thinned, light weight, multifunctional C-MAC system interface (Figure 2D). In addition, the manufacturer also released a disposable C-MAC device, offering 2 adult blades (size 3 and 4) (Figure 2D). 80 The disposable C-MAC device consists of a disposable Macintosh plastic blade, a picture tube with a camera, and a monitor. The picture tube is inserted into the disposable plastic blade to prevent oral contamination. However, disposable plastic blades are not exactly the same as reusable metal blades. The webs and flanges of the disposable plastic blades are significantly thickened to avoid breakage during use. When using disposable plastic blades, these additional volumes reduce the pharynx field of vision and limit the space for operating the endotracheal tube. 12

Since the C-MAC video laryngoscope uses a Macintosh blade, the larynx can be seen under direct vision or on a monitor. In other words, the airway view on the monitor is similar to what you see when looking directly at the mouth. 7 Therefore, this device is unique among video laryngoscopes because it can be used as both a video laryngoscope and a direct laryngoscope. This function may be useful in situations where the video is malfunctioning or there is a secretion on the lens. 6 However, one disadvantage of using the Macintosh blade is that it is often necessary to align the 3 airway shafts and the extralaryngeal pressure in order to obtain a good view of the larynx during the laryngoscopy.

Figure 3 C-MAC video laryngoscope with disposable plastic blade. Note: (A) Video monitor; (B) C-MAC D-Blade electronic laryngoscope with disposable plastic blade; (C) C-MAC video laryngoscope with disposable Macintosh blade. Copyright © KARL STORZ GmbH & Co. KG Germany.80

Intubation procedure using C-MAC video laryngoscope

When used as a direct laryngoscope, the intubation process of the C-MAC video laryngoscope is the same as that of a traditional Macintosh laryngoscope. Insert the device into the right side of the mouth, move the tongue to the left through the blade flange, advance the tip of the blade to the epiglottic valve, and then lift the device to obtain a view of the larynx. 11 Obtain a view of the larynx, and optimize operations including external throat pressure and blade position adjustment, such as straight blade technology to raise the epiglottis. 13 The insertion of the endotracheal tube depends on the intubator’s preference for direct laryngoscopy, when it is necessary to use a stylet and the angle of the needle tube when it is bent. 8

When used as a video laryngoscope, taking into account the advantageous position under the tongue base, the midline insertion technique does not need to sweep the tongue to obtain an unobstructed view of the larynx. 7 Although a stylet is not always needed, it is very helpful for pulling the tip of the tube up to the glottis, especially in patients with difficult airways. A study comparing the performance of different video laryngoscopes in patients with normal airways showed that in 10%, 76% and 60% of cases using C-MAC, McGrath and Glidescope video laryngoscopes, respectively Tube needle. 14 In patients undergoing elective cervical spine surgery, use manual online stabilizers to stabilize the head and neck, use stylets to significantly reduce the intubation difficulty scale score, intubation time, and use elasticity probes with C-MAC video laryngoscopes. strip. 15 When C-MAC uses a stylet, however, the video laryngoscope does not require the sharp bend of the distal side of the needle tube because the proximal shape of the blade provides a relatively straighter path for intubation, especially in patients with normal airways . In contrast, acute-angle video laryngoscopes, such as Glidescope video laryngoscopes, usually require a significant bending angle of the distal side of the needle tube in order to "round the corner" of the endotracheal tube to the glottis. 11

Performance of C-MAC Video Laryngoscope vs. Direct Laryngoscope

The video laryngoscope was originally designed as a device for managing difficult intubation during direct laryngoscopy. 6 Although this is true, it does not capture the main point, and it is only used to predict difficult intubation or intubation that proves to be difficult after direct laryngoscopy has failed. In fact, with the accumulation of intervention experience, the successful application of any device can be improved. If the visual laryngoscope is used for all patients, it will undoubtedly increase experience and skills, reduce the number of intubation times and complications from multiple attempts, and improve patient care. 4,16 It has been suggested that the best visual laryngoscope should be provided for all patients without obvious limitations, not limited to those considered to be the most difficult. 17 In addition, the advantages of C-MAC video laryngoscopy combine the advantages of direct and video laryngoscopy in one device, making it suitable as a standard intubation tool for routine airway management. 7

In the existing literature, 3 observational trials compared the direct and indirect (video monitor) laryngeal view display in adult patients with normal airways using V-MAC or C-MAC video laryngoscope, compared with direct visualization, Video-assisted laryngoscopes provide an improved view of the larynx.14,18,19 In addition, there are several randomized controlled trials (RCTs) comparing V-MAC or C-MAC video laryngoscopes and direct laryngoscopes in adult patients with normal airways The performance of oral endotracheal intubation. 10,20-25 Cavus et al10 found that the C-MAC video laryngoscope provides a view of the larynx that is equivalent to or better than that of the direct laryngoscope, and the intubation time between the direct laryngoscope and the video laryngoscope is equivalent. Sarkilar et al20 compared the performance and hemodynamic response of the Macintosh laryngoscope and the C-MAC video laryngoscope during intubation, and proved that the C-MAC device provides a better view of the larynx and a longer intubation time. However, the number of intubation attempts, the use of extralaryngeal pressure, or the stylet and hemodynamic response of orotracheal intubation are comparable between the two devices. Lee et al.21 found that compared with Macintosh laryngoscopes, the V-MAC device provides a better view of the larynx, requires fewer intubation attempts and shorter intubation time. Bhat et al. 22 showed that for patients in the right decubitus position, C-MAC video laryngoscope can improve the visual field of the larynx, reduce intubation time, reduce airway mucosal damage and reduce the use of extralaryngeal procedures, but the overall success rate of intubation This is equivalent to the number of intubation attempts between C-MAC and Macintosh devices. Three RCTs 21, 23, and 24 proved that, compared with direct laryngoscopy, V-MAC and C-MAC video laryngoscopes exert lower force on the maxillary incisors during laryngoscopy. However, a prospective randomized parallel group study confirmed that the C-MAC video laryngoscope has a significantly increased hemodynamic response to intubation compared to the Macintosh laryngoscope. 25

A retrospective analysis compared the use of a Macintosh laryngoscope and a C-MAC video laryngoscope to place a dual-lumen tube in patients without predictors of difficulty in intubation, and showed that the C-MAC device provides an improved view of the larynx and increases The convenience of operation is improved, but no benefit is provided regarding the number of intubation attempts. 26

Since the original purpose of the video laryngoscope is to solve the main problems of difficult airway and difficult intubation, it has quickly become a first-line strategy for potential and/or difficult intubation. 6 In addition, most current managers of difficult airway algorithms recommend video laryngoscopy as a rescue strategy for difficult direct laryngoscopy or failed intubation. 27-29 There are many studies that have evaluated the application and role of C-MAC video laryngoscope in difficult airway management.

Two RCTs compared the effectiveness of V-MAC and C-MAC video laryngoscopes with direct laryngoscopes in predicting the effectiveness of oral endotracheal intubation in patients with difficult airways. The results show that video laryngoscopes can provide better laryngeal vision, In the first attempt, more successful intubation, shorter laryngoscopy and intubation time, and reduce the need for adjuvants, but does not affect the incidence of complications. 30,31

Patients with cervical spine injury often need to use a semi-rigid neck brace or manual online stabilization to prevent neck movement, which may lead to poor visual field of the larynx during direct laryngoscopy and difficult intubation. 2 To simulate patients with difficult airway fixation through the cervical spine, C-MAC video laryngoscope provides a better laryngeal field of vision compared with direct laryngoscope, 15,32,33 but in the time of intubation, number of intubation attempts, and successful intubation There is no decisive benefit in terms of rate and complication rates. 15,32 In addition, despite the good view of the larynx, the placement of the endotracheal tube may sometimes fail. 33 In morbidly obese patients, the V-MAC or C-MAC video laryngoscope improves the visual field of the larynx and allows rapid tracheal intubation compared to the Macintosh laryngoscope. 34,35

Of the 51 patients who had accidental Cormack and Lehane level 3 or 4 views using the Macintosh laryngoscope, 49 patients (94%) achieved improved laryngeal views and successful intubation using the C-MAC video laryngoscope. 36 42 patients who tried to use Macintosh for intubation failed. C-MAC video laryngoscope improved the view of the larynx. The success rate of the first intubation attempt reached 86%, and the total success rate of intubation reached 100%, except for minor ones. There are no serious complications other than airway injury. 37 In patients with morbidly obesity (body mass index [BMI] 36 kg/m2), 3 attempts of Macintosh direct laryngoscopy failed, and each time resulted in a Cormack-Lehane level 4 view. 38 However, endotracheal intubation using V-MAC video laryngoscope was successful in the first attempt. These data provide evidence for the clinical effectiveness of C-MAC video laryngoscope as an effective rescue device for unexpectedly difficult laryngoscopy or intubation failure in routine anesthesia care.

Patients requiring tracheal intubation in the emergency department, intensive care unit (ICU), and prehospital environment are typical emergencies associated with impaired hemodynamics and respiratory dysfunction. For many reasons, even if the clinician has sufficient airway skills, these patients are usually at high risk of difficulty in laryngoscopy and intubation. If inexperienced clinicians are responsible for managing the airway in this challenging condition, the risk of difficult laryngoscopy and intubation may further increase. 2 Therefore, compared with elective intubation in the operating room, there is an increased rate of failed attempts and complications during emergency intubation. In addition, the complications of emergency intubation are independently related to repeated attempts. 39 Given that the goal of emergency intubation is to succeed in the first attempt, the use of video laryngoscope in emergency airway management has increased significantly; it has also been shown to increase the success rate of intubation in the first attempt. 40

The option to perform direct and video laryngoscopy using the same device makes the C-MAC device particularly suitable for emergency intubation. If the direct laryngoscope attempt fails, the intubator can immediately switch to the video laryngoscope to successfully complete the intubation without a second attempt, and vice versa. 41,42 Multiple observational and retrospective studies of patients from the emergency department, pre-hospital and ICU showed that compared with direct laryngoscopy, V-MAC or C-MAC devices have significantly better visualization and higher levels of the larynx The proportion of successful intubation is relevant, especially for patients who predict difficult intubation. 43-47 In addition, the use of C-MAC video laryngoscope during emergency intubation significantly reduces the number of esophageal intubations compared to direct laryngoscopy. 43,48,49

In a retrospective analysis of 619 consecutive emergency patients, Vassiliadis et al50 found that the C-MAC video laryngoscope did not provide a better laryngeal field of view than the Macintosh laryngoscope, but when the Cormack-Lehane grade was at least 3 It is superior to the Macintosh laryngoscope at the first level; that is, by using the C-MAC video laryngoscope, the chance of successful intubation is increased by more than 3 times. After the failure of the first emergency intubation attempt, the C-MAC video laryngoscope proved to be more successful than the direct laryngoscope on the second attempt, regardless of the equipment used initially. 51

However, in the existing literature, V-MAC or C-MAC video laryngoscopes are not effective in emergency intubation. Brown et al46 compared the direct and indirect laryngeal views obtained by the V-MAC video laryngoscope. A small proportion of patients (3%) had worse laryngeal views when switching from direct laryngoscope to video laryngoscope, and all 6% of intubation attempts using video laryngoscopes failed. A multicenter observational study conducted by Cavus et al. 41 evaluated the failure rate of C-MAC video laryngoscopes during emergency prehospital intubation performed by doctors. Is 7.5%. In these two studies, the reasons for the failure of the video laryngoscopy included technical problems (monitor failure and low battery power) or obstructed vision caused by airway blood and secretions. In addition, direct laryngoscopy for tracheal intubation (using the C-MAC blade as a traditional Macintosh blade) is the main rescue measure for failed video laryngoscopy. 41,46

A non-randomized controlled trial comparing C-MAC video laryngoscope and direct laryngoscope in the intensive care transport service showed that the C-MAC device has better laryngo vision, but the number of attempts, first pass success rate and airway rescue The use is similar to 52 So far, 3 RCTs have compared the role of C-MAC video laryngoscope and direct laryngoscope in emergency intubation, and all show that video laryngoscope is not beneficial to intubation success rate and intubation time. 49,53,54 Experiments conducted by Sulser et al.53 showed that rapid sequence emergency intubation was performed by experienced anesthesiologists. The results showed that the C-MAC video laryngoscope improved the visualization of the larynx, but better visualization of the larynx did not increase the success rate of intubation at the first attempt and intubation time. A study by Goksu et al.49 showed that C-MAC video laryngoscopes and direct laryngoscopes are comparable in terms of overall intubation success rate and intubation time. C-MAC devices provide an improved view of the larynx. Driver et al. 54 also did not find the intubation success rate of direct laryngoscopy and video laryngoscopy in the first attempt, intubation time, aspiration pneumonia, or direct laryngoscopy and video laryngoscopy in emergency patients. There are differences in the length of hospitalization during intubation. Attempt to use laryngoscopy for the first time.

Based on the existing evidence of the emergency intubation study mentioned above, it can be concluded that compared with the direct laryngoscope, the C-MAC video laryngoscope can provide a better view of the larynx, but whether the improved laryngeal view will cause intubation Although the success rate increases and decreases, the results are contradictory. Intubation time. The visualization of the airway on the monitor may help intubators who are less experienced in airway management and may reduce the incidence of esophageal tube misalignment.

Performance comparison between C-MAC video laryngoscope and other equipment

There are many video laryngoscopes available, and their efficacy may vary due to their different designs and shapes. In order to select these devices to manage various airway conditions, it is necessary to compare the performance of different video laryngoscopes in patients with different conditions. For patients with normal airways who require oral endotracheal intubation, Lee et al55 compared Bonfils intubation fiberscope and C-MAC video laryngoscope, and the results showed that there was no difference in the success rate of the first intubation between the two devices, but The time required for intubation with the C-MAC device is relatively short and results in a significantly reduced hemodynamic response. Among healthy volunteers undergoing awake upright laryngoscopy, the Glidescope video laryngoscope provided a better field of view than the C-MAC video laryngoscope, but the laryngoscopy time and the number of intubation attempts were similar between devices. 56

In a prospective RCT performed on patients predicted to have a difficult airway, the Glidescope video laryngoscope was able to obtain a significantly better view of the larynx than the C-MAC video laryngoscope, but the laryngoscope examination time, the number of intubation attempts, and the There is no difference in the success rate of intubation between instruments. 57 Comparing McGrath and Ng et al.58 found that compared with McGrath devices, C-MAC devices can shorten the intubation time, reduce the number of intubation attempts, and make intubation easier. In patients with cervical spine disease and immobilization, Glidescope and C-MAC video laryngoscope provide comparable views of the larynx, but the C-MAC device has a higher first attempt failure rate and requires more intubation attempts and optimized operations. 59 In addition, an RCT conducted in obese patients undergoing bariatric surgery showed that the V-MAC video laryngoscope significantly shortened the intubation time compared with the McGrath and Glidescope devices. Compared with the McGrath device, the required insertion The number of tubes and the frequency of use of auxiliary intubation equipment are lower. 35 In addition, a retrospective study comparing Glidescope and C-MAC video laryngoscope in patients requiring emergency intubation showed that the first pass success rate and overall success rate of the two devices were similar. 60

Yumul et al61 compared the application of C-MAC video laryngoscope and flexible fiber optic endoscope in patients with cervical spine fixation through a prospective randomized study, and found that the C-MAC device significantly reduced the acquisition of laryngeal views and successful intubation The time required.

In a multi-center, prospective, non-randomized clinical trial comparing C-MAC and KingVision video laryngoscopes for pre-hospital emergency intubation, the success rate and overall success rate of the C-MAC device in the first attempt of intubation were significantly improved , And requires fewer intubation attempts, but the two devices are similar in intubation complications. 62

The above research results show that when trying to protect the airway, no device is better than others under all conditions. Each device has unique characteristics, which may be beneficial in some situations, but may be limited in other situations. 6 Therefore, healthcare providers involved in airway management must have several different devices. In addition, video laryngoscopes must be selected according to the indications. 4

C-MAC video laryngoscope endotracheal intubation teaching

Teaching direct laryngoscopy to students may be related to the anxiety of teachers and students. This can be partly attributed to the fact that the teacher cannot see what the introducer is (or is not) visualizing during the operation. The video laryngoscope provides a shared view for teachers and students; that is, the high-quality magnified picture on the video laryngoscope monitor allows teachers to explain the anatomy of the upper respiratory tract and the procedures of the laryngoscope and intubation to the students. 1 In addition, when students try to intubate, teachers can see the monitor and provide real-time feedback. Therefore, the use of video laryngoscopy replaces the teaching method of "peer on my shoulder", which saves a lot of time and avoids many unnecessary intubation attempts. 5

C-MAC video laryngoscope is a very good teaching tool for tracheal intubation, because it has a standard Macintosh blade, so the intubation process is the same as the traditional one. Studies have shown that, compared with direct laryngoscope training, V-MAC or C-MAC video laryngoscope video-assisted teaching can shorten the learning curve of direct laryngoscope intubation for students, increase the success rate of intubation, and reduce the rate of esophageal intubation. Intubation. 63,64 After training, compared with novices trained with Macintosh laryngoscopes, novices trained with C-MAC video laryngoscopes experienced intubation attempts, required repositioning operations, and simulated dental trauma under difficult airway conditions Performance is better. 65 Due to the compact video system, C-MAC video laryngoscope was also welcomed by the students during the intubation training in the simulated field hospital. 66

However, a randomized, cross-over study that evaluated the retention of laryngoscopy skills of medical students showed that there was no significant difference in the median intubation time after training for students trained with C-MAC and Macintosh devices, but there was no significant difference in the short-term The median intubation time after practice is longer than that of students trained with Macintosh devices. Students trained with C-MAC devices take longer. 67 This shows that the intubation skills using C-MAC video laryngoscope can be achieved through short learning and practice, but the maintenance of skills requires regular practice.

The video laryngoscope creates a visual advantage by placing the eye of the intubator close to the tip of the knife, beyond the obstructed anatomy of the upper airway. In the past ten years, video laryngoscopes have received widespread attention as a new airway device. In current clinical practice, video laryngoscopy has actually been used in any situation that requires tracheal intubation and has led to major changes in airway management strategies. 6 Video laryngoscopy is even considered a viable alternative to direct laryngoscopy. 4,68 However, it is important that the new intubation devices should prove to be at least as safe and effective as direct laryngoscopes to justify the cost of acquisition and our need to use them proficiently.

Existing evidence shows that for patients with normal airways, compared to direct laryngoscopes, V-MAC or C-MAC video laryngoscopes can provide equivalent or better views of the larynx and exert less force on the maxillary incisors , But did not provide decisive benefits in terms of intubation time, success rate of intubation, number of intubation attempts, use of auxiliary equipment, and hemodynamic response to intubation. 10,14-26 It should be noted that the current airway assessment is based on the difficult intubation of direct laryngoscopy, but the difficult intubation predicted by direct laryngoscopy does not mean that intubation using video laryngoscopes will be difficult ,vice versa. 69 In addition, good visualization of the larynx during intubation has been shown to directly affect patient safety and morbidity. 70 Therefore, having high-performance equipment is very important for airway management. In view of the fact that C-MAC video laryngoscope with standard blade combines the advantages of direct laryngoscope and video laryngoscope in one device, we agree with the views of other authors that C-MAC video laryngoscope can be used as a standard for routine airway management Intubation equipment. 4,10

The benefits of C-MAC video laryngoscope are most significant in patients with difficult airways, because it can convert a "blind" intubation into a visually controlled intubation. For patients with predicted or known difficult airways, compared with direct laryngoscopy, the C-MAC device can achieve better laryngoscopic vision, higher intubation success rate and shorter intubation time. 30,31,34,35 In addition, the C-MAC device has proven to be an effective rescue device for unexpectedly difficult laryngoscopy or failed intubation. 36-38 Therefore, C-MAC video laryngoscope can produce clinically relevant improvements in intubation conditions and can be recommended for difficult airway management. However, for patients with airway difficulties caused by cervical spine fixation, although the visualization of the larynx is very good, the use of the C-MAC device may prolong the intubation time, and the tracheal intubation may sometimes fail. 32,33 In addition, the performance of the Glidescope video laryngoscope is better than that of the C-MAC video laryngoscope.59 These problems should be paid attention to when choosing the right video laryngoscope to deal with special airway diseases.

For the emergency airway, most observational and retrospective studies have shown that the C-MAC device performs better than direct laryngoscopes, especially for Cormack-Lehane grade 3 or 4.41-48,50,51 after the first intubation failure in the emergency department For patients, the C-MAC device was more successful than the direct laryngoscope on the second attempt. 51 However, all existing RCTs comparing C-MAC video laryngoscopes and direct laryngoscopes for emergency intubation have not shown the benefits of C-MAC video laryngoscopes on intubation success rate and intubation time. 49,53,54 The detailed reasons for the inconsistent results obtained from observational and randomized controlled studies are unclear, but several important issues can be considered. First, observational and retrospective studies have major flaws in methodology and may introduce many confounding variables. Second, most studies did not clearly describe the location of the patient. This may not be important for video laryngoscopy that does not require alignment of the airway axis to expose the larynx. 6 However, the position of the patient’s head and neck can significantly affect the performance of direct laryngoscopy, because direct laryngoscopy requires the axis of the airway to be aligned more straight. 71 Third, most studies require some training and exercises on the equipment studied before the study, but the capabilities of the equipment studied by the intubator are not clearly defined. In addition, most intubation attempts for the first time are done by inexperienced intubation personnel. In fact, the experience of using standard laryngoscopes is not equivalent to the skills of video laryngoscopes. 4 For video laryngoscopes, the main challenge for the intubator is to become familiar with the view on the monitor and to coordinate the eyes and hands appropriately. 1 If the intubator has more direct laryngoscopy and video laryngoscopy experience, the higher success rate of intubation is related to the previous equipment. If the intubator has no experience in direct laryngoscopy, video laryngoscopy may be associated with a better success rate of intubation. Therefore, the difference in intubation performance between C-MAC video laryngoscope and direct laryngoscope in these studies may be due to their different learning curves. It has been emphasized that in order for the results of the comparative study to be valid, participants must be equally proficient with each airway device to avoid deviations. 72 Fourth, the use of neuromuscular blockers has been shown to increase the success rate of the first attempt. Emergency intubation, 73, 74 However, this factor varies significantly in different studies. Fifth, some studies have excluded patients with expected or known difficult airways, although C-MAC video laryngoscopes are more effective than direct laryngoscopes in such situations. 50,51

It must be emphasized that when considering the role of C-MAC video laryngoscope in ensuring the airway for patients in need of emergency intubation, an important fact is that one device can provide both direct laryngoscope and video laryngoscope. That is, when one option of the first attempt fails, the intubator can immediately switch to another option to successfully complete the intubation without the need for a second attempt. 41,42 This unique feature of the C-MAC device is significantly different from the angular one. Video laryngoscopes, such as C-MAC D-Blade and Glidescope devices that can only provide video laryngoscope options. In view of the fact that there is no algorithm that can reliably predict emergency intubation directly before intubation or difficult video laryngoscopy, emergency patients are not allowed to try intubation multiple times, 50, 51, 75 we think that using C-MAC video laryngoscope and 2 options Being the main emergency intubation device may be a safety procedure and should be the first line device for all emergency intubation. A recent meta-analysis of observational, retrospective, and random data compared video and direct laryngoscopy for orotracheal intubation in ICU patients, indicating that the first attempt to use video laryngoscopy is likely to be successful. Times. 40 In addition, the biggest tendency-to date, a matching analysis comparing video and direct laryngoscopy in the ICU shows that the first attempt of video laryngoscopy has a higher success rate and a lower complication rate. 76 Therefore, some emergency medical airway experts call for video laryngoscopes to replace direct laryngoscopes for tracheal intubation in all emergency patients. 16,50,51,68,77,78

However, clinicians should keep in mind that no single device can provide a solution for all airway conditions. C-MAC video laryngoscope provides a high intubation success rate, but it cannot provide a 100% success rate. 33,41,46 In order to manage airway conditions quickly and safely, practitioners must master several different airway equipment and techniques. In addition, any difficult airway management strategy, including video laryngoscopes, must include a failed contingency plan. 79

Finally, this review has some limitations. First, there is a high degree of heterogeneity among the included studies, such as the experience and skill level of the equipment studied, the intubation strategy, and the definition of the main results of the intubator. Secondly, none of the randomized controlled trials included in this review are double-blind studies because it is impossible for intubators to be unaware of the equipment they will use for intubation. Third, most studies have a small sample size, and the airway conditions of the patients are different. Fourth, many studies on difficult and urgent intubation only evaluated the differences in intubation variables between C-MAC video laryngoscopes and direct laryngoscopes, but did not evaluate clinical outcomes, such as patient morbidity and mortality. Therefore, it is not clear whether the beneficial effects of C-MAC video laryngoscopes on intubation results can be translated into clinical benefits. These factors may complicate the interpretation of the clinical performance of C-MAC video laryngoscopes.

A unique feature of the C-MAC video laryngoscope with Macintosh blade is that it can provide direct laryngoscope and video laryngoscope options in the same device. It makes the use of C-MAC video laryngoscope very attractive. So far, the role of C-MAC video laryngoscope in airway management and education has been fully confirmed by published literature. Existing evidence supports that C-MAC video laryngoscope can be used as the main intubation tool, especially when the intubator lacks airway management experience and preoperative airway screening suggests that intubation is difficult. It can improve patient safety by avoiding unnecessary intubation attempts and facilitating direct and video laryngoscopy learning. Therefore, the emergence of C-MAC video laryngoscopes has expanded the equipment of healthcare providers involved in airway management. However, the biggest obstacle to widespread use of this device may be cost, as it is currently one of the most expensive video laryngoscopes. In addition, the introduction of C-MAC equipment in clinical practice must be accompanied by a formal training program for normal and difficult airway management.

Xue FS made substantial contributions to data acquisition and data interpretation, drafted and revised this manuscript, and was responsible for this manuscript. HX Li, YY Liu and GZ Yang made substantial contributions to data acquisition and data interpretation, and helped write the manuscript. All authors have read and approved the final manuscript.

The authors report no conflicts of interest in this work.

Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video laryngoscopy in adult airway management: a literature review. Acta anesthetic scan. 2010;54(9):1050–1061.

Maldini B, HodžoviĆ I, GoranoviĆ T, MesariĆ J. The challenge of using video laryngoscopes. Croatian Clinical Journal. 2016; 55 (Supplement 1): 41-50.

Paolini JB, Donati F, Drolet P. Review article: Video laryngoscopy: another tool for difficult intubation or a new paradigm for airway management? Can J Anesth. 2013;60(2):184–191.

Kelly FE, Cook TM. Seeing is believing: make the most of video laryngoscopy. Br J Anaesth. 2016; 117 (Supplement 1): 9-13.

Kaplan MB, Ward DS, Berci G. A new video laryngoscope-an aid to intubation and teaching. J Clinical anesthesia. 2002;14(8):620–626.

Xue FS, Liu Qingjie, Li Haixia, Liu YY. Video laryngoscopy assisted intubation—a new era of airway management. J Anesth Perioper Med. 2016;3(6):258-269.

Aziz M, Brambrink A. Storz C-MAC video laryngoscope: description of the new device, case report and short case series. J Clinical anesthesia. 2011;23(2):149-152.

Green-Hopkins I, Nagler J. Tracheal intubation of pediatric patients using video laryngoscopy: an evidence-based review. Pediatr Emerg Med Pract. 2015;12(8):1-22.

Holm-Knudsen R. Difficult pediatric airway-a review of new devices for indirect laryngoscopy in children under two years of age. Pediatric anesthesia. 2011;21(3):98-103.

Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. During the induction of conventional anesthesia for 150 patients, a randomized, controlled cross-comparison between C-MAC video laryngoscope and direct laryngoscope. BMC anesthetics. 2011; 11:6.

Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexity of endotracheal intubation using direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011;57(3):240–247.

Greenland KB. Disposable C-MAC® video laryngoscope blades-different from reusable blades. anaesthetization. 2014;69(12):1402-1403.

Cavus E, Kieckhaefer J, Doerges V, Moeller T, Thee C, Wagner K. C-MAC Video Laryngoscope: It is the first time to experience the new equipment of video laryngoscope to guide intubation. Anesthesia analysis. 2010;110(2):473–477.

van Zundert A, Maassen R, Lee R, etc. The Macintosh laryngoscope blade for video laryngoscopy reduces the number of tube needles used in patients with normal airways. Anesthesia analysis. 2009;109(3):825–831.

Gupta N, Rath GP, Prabhakar H. C-MAC video laryngoscope is used or not to perform clinical evaluation of endotracheal intubation for patients with cervical spine fixation. J Anesthesia. 2013;27(5):663–670.

Brown CA 3rd, Pallin DJ, Walls RM. Video laryngoscopy and intubation safety: perspectives are becoming clear. Critical Nursing Medicine. 2015; 43(3): 717–718.

The use of Agro FE, Doyle DJ, Vennari M. GlideScope® in adults: an overview. Minerva Anestesiol. 2015; 81(3): 342–351.

Kaplan MB, Hagberg CA, Ward DS, etc. Comparison of direct view and video-assisted view of the larynx during conventional intubation. J Clinical anesthesia. 2006;18(5):357–362.

Shimada N, Motegi K, Niwa Y, etc. C-MAC video laryngoscope: its practicality in novice tracheal intubation. Shengjing. 2012; 61(6): 649–452.

Sarkilar G, Sargin M, Saritaş TB, etc. The hemodynamic response of patients planning to undergo major cardiac surgery to tracheal intubation through video and direct laryngoscopy. Int J Clin Exp Med. 2015; 8(7): 11477-11483.

Lee RA, van Zundert AA, Maassen RL, Wieringa PA. The force applied by the video laryngoscope and Macintosh laryngoscope to the maxillary incisors. Acta anesthetic scan. 2012;56(2):224-229.

Bhat R, Sanickop CS, Patil MC, Umrani VS, Dhorigol MG. Macintosh laryngoscope and C-MAC video laryngoscope are used for comparison of lateral intubation. J Clinical Pharmacology of Anesthetics. 2015;31(2):226-229.

Pieters B, Maassen R, Van Eig E, Maathuis B, Van Den Dobbelsteen J, Van Zundert A. Indirect video laryngoscopy of patients with unexpectedly difficult airways using Macintosh blades, compared with traditional direct laryngoscopy, The force on the teeth is significantly reduced: a random crossover test. Minerva Anestesiol. 2015;81(8):846–854.

Lee RA, van Zundert AA, Maassen RL, etc. The force applied to the maxillary incisor during video-assisted intubation. Anesthesia analysis. 2009;108(1):187–191.

Buhari FS, Selvaraj V. A randomized controlled study comparing the hemodynamic response of adult patients with McCoy, Macintosh and C-MAC laryngoscopy to laryngoscopy and tracheal intubation. J Clinical Pharmacology of Anesthetics. 2016;32(4):505–509.

Purugganan RV, Jackson TA, Heir JS, Wang H, Cata JP. Video laryngoscope and direct laryngoscope for double-lumen endotracheal intubation: retrospective analysis. J Cardiothoracic vascular anesthesia. 2012;26(5):845–848.

Apfelbaum JL, Hagberg CA, Caplan RA, etc. Difficult Airway Management Practice Guidelines: An updated report from the Difficult Airway Management Working Group of the American Academy of Anesthesiologists. Anesthesiology. 2013;118(2):251-270.

Frerk C, Mitchell VS, McNarry AF, etc. The Difficult Airway Association 2015 Guidelines for the Management of Unexpected Difficulty Intubation in Adults. Br J Anaesth. 2015;115(6):827–848.

Japanese Society of Anesthesiologists. JSA Airway Management Guidelines 2014: Improve the safety of induction of anesthesia. J Anesthesia. 2014;28(4):482–493.

Jungbauer A, Schumann M, Brunkhorst V, Börgers A, Groeben H. Anticipating difficult endotracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients. Br J Anaesth. 2009;102(4):546–550.

Aziz MF, Dillman D, Fu R, Brambrink AM. The comparative effect of C-MAC video laryngoscope and direct laryngoscope in predicting difficult airway settings. Anesthesiology. 2012;116(3):629–636.

Byhahn C, Iber T, Zacharowski K, etc. Use mobile C-MAC video laryngoscope or direct laryngoscope to simulate the tracheal intubation for patients with difficult airways. Minerva Anestesiol. 2010;76(8):577–583.

Akbar SH, Ooi JS. Comparison of C-Mac video laryngoscope and Macintosh direct laryngoscope in cervical spine fixation. Middle East J narcotic. 2015;23(1):43-50.

The clinical experience of Gaszyński T. C-Mac video laryngoscope in morbidly obese patients. Intensive anesthesia treatment. 2014;46(1):14-16.

Yumul R, Elvir-Lazo OL, White PF, etc. Comparison of three video laryngoscope equipment and direct laryngoscope in intubation in obese patients: a randomized controlled trial. J Clinical anesthesia. 2016; 31:71-77.

Piepho T, Fortmueller K, Heid FM, Schmidtmann I, Werner C, Noppens RR. The performance of C-MAC video laryngoscope in patients with limited glottis using Macintosh laryngoscope. anaesthetization. 2011;66(12):1101–1105.

Kilicaslan A, Topal A, Tavlan A, Erol A, Otelcioglu S. The effectiveness of C-MAC video laryngoscope in the management of accidental failed intubation. Braz J anesthetics. 2014;64(1):62-65.

Maassen R, Lee R, van Zundert A, Cooper R. For obese patients with difficult airways, video laryngoscopes are less traumatic than classic laryngoscopes. J Anesthesia. 2009;23(3):445–448.

Cook TM, Woodall N, Harper J, Benger J. Major complications of British airway management: the results of the fourth national audit project of the Royal College of Anesthesiologists and the Difficult Airway Society. Part 2: Intensive Care and Emergency Department. Br J Anaesth. 2011;106(5):632–642.

De Jong A, Molinari N, Conseil M, etc. Video laryngoscopy and direct laryngoscopy of oral endotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive care medicine. 2014;40(5):629–639.

Cavus E, Callies A, Doerges V, etc. C-MAC video laryngoscope for emergency pre-hospital intubation: a prospective, multicenter, observational study. Emerg Med J. 2011;28(8):650-653.

Sakles JC, Mosier JM, Patanwala AE, Arcaris B, Dicken JM. The practicality of C-MAC as a direct laryngoscope for intubation in the emergency department. J Emerg Med. 2016;51(4):349-357.

Sakles JC, Mosier J, Chiu S, Cosentino M, Kalin L. Comparison of C-MAC video laryngoscope and Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012; 60(6): 739–748.

Noppens RR, Geimer S, Eisel N, David M, Piepho T. Tracheal intubation using C-MAC video laryngoscope or Macintosh laryngoscope: a prospective comparative study in the ICU. Critical care. 2012; 16(3): R103.

Hossfeld B, Frey K, Doerges V, Lampl L, Helm M. Improving the visualization of the glottis using the C-MAC PM video laryngoscope as a first-line device for emergency endotracheal intubation outside the hospital: an observational study. Eur J anesthetics. 2015; 32(6): 425–431.

Brown CA 3rd, Bair AE, Pallin DJ, Laurin EG, Walls RM; National Emergency Airway Registry (NEAR) investigator. Use Video Macintosh Laryngoscope to improve glottal exposure in adult emergency department endotracheal intubation. Ann Emerg Med. 2010;56(2):83-88.

Jones BM, Agrawal A, Schulte TE. Through retrospective comparison of 436 cases of emergency intubation, the efficacy of video laryngoscope and direct laryngoscope was evaluated. J Anesthesia. 2013;27(6):927–930.

Sakles JC, Javedani PP, Chase E, Garst-Orozco J, Guillen-Rodriguez JM, Stolz U. The use of video laryngoscopy by emergency department residents is associated with the reduction of esophageal intubation in the emergency department. Acad Emerg Med. 2015;22(6):700–707.

Goksu E, Kilic T, Yildiz G, Unal A, Kartal M. Comparison of C-MAC video laryngoscope and Macintosh laryngoscope in the intubation of patients with blunt trauma in the emergency department. Turk J Emerg Med. 2016;16(2):53-56.

Vassiliadis J, Tzannes A, Hitos K, Brimble J, Fogg T. Comparison of C-MAC video laryngoscope and direct Macintosh laryngoscope in emergency department. Emerg Med Australas. 2015;27(2):119-125.

Sakles JC, Mosier JM, Patanwala AE, Dicken JM, Kalin L, Javedani PP. C-MAC video laryngoscope is better than direct laryngoscope when the first attempt of intubation fails in emergency department rescue. J Emerg Med. 2015;48(3):280–286.

Guyette FX, Farrell K, Carlson JN, Callaway CW, Phrampus P. Comparison of video laryngoscopy and direct laryngoscopy in intensive care transport services. Pre-hospital emergency care. 2013;17(2):149–154.

Sulser S, Ubmann D, Schlaepfer M, etc. Comparison of C-MAC video laryngoscope and direct laryngoscope for rapid sequential intubation in the emergency department: a randomized clinical trial. Eur J anesthetics. 2016;33(12):943–948.

Driver BE, Prekker ME, Moore JC, Schick AL, Reardon RF, Miner JR. Direct laryngoscopy and video laryngoscopy using C-MAC for emergency tracheal intubation, a randomized controlled trial. Acad Emerg Med. 2016;23(4):433–439.

Lee AH, Nor NM, Izaham A, Yahya N, Tang SS, Manap NA. Comparison of Bonfils intubation fiberscope and C-MAC video laryngoscope. Middle East J narcotic. 2016;23(5):517–525.

Drenguis AS, Carlson JN. GlideScope comparison. C-MAC is used for awake upright laryngoscopy. J Emerg Med. 2015;49(3):361–368.

Serocki G, Bein B, Scholz J, Dörges V. Predicting the management of difficult airways: a comparison of traditional blade laryngoscopes with video-assisted blade laryngoscopes and GlideScope. Eur J anesthetics. 2010;27(1):24-30.

Ng I, Hill AL, Williams DL, Lee K, Segal R. A randomized controlled trial comparing the effects of McGrath video laryngoscope and C-MAC video laryngoscope in adult patients with potentially difficult airway intubation. Br J Anaesth. 2012;109(3):439–443.

Brook S, Trautner H, Wolf A, etc. Comparison of C-MAC and GlideScope video laryngoscope in patients with cervical spine disease and immobilization. anaesthetization. 2015;70(2):160–165.

Mosier J, Chiu S, Patanwala AE, Sakles JC. Comparison of GlideScope video laryngoscope and C-MAC video laryngoscope for intubation in emergency department. Ann Emerg Med. 2013; 61(4): 414-420.

Yumul R, Elvir-Lazo OL, White PF, etc. Comparison of C-MAC video laryngoscope and flexible fiber optic endoscope for fixed intubation of the cervical spine. J Clinical anesthesia. 2016; 31:46-52.

Burnett AM, Fracone RJ, Wewerka SS, etc. Comparison of the success rate of the two video laryngoscope systems used in pre-hospital clinical trials. Pre-hospital emergency care. 2014;18(2):231–238.

Howard-Quijano KJ, Huang YM, Matevosian R, Kaplan MB, Steadman RH. Video-assisted teaching improves the success rate of novice tracheal intubation. Br J Anaesth. 2008;101(4):568–572.

Herbstreit F, Fassbender P, Haberl H, Kehren C, Peters J. Using the new video laryngoscope to learn tracheal intubation has improved the intubation skills of medical students. Anesthesia analysis. 2011;113(3):586–590.

Low D, Healy D, Rasburn N. Use BERCI DCI video laryngoscopy to teach novice direct laryngoscopy and tracheal intubation. anaesthetization. 2008;63(2):195-201.

Boedeker BH, Bernhagen MA, Miller DJ, Miljkovic N, Kuper GM, Murray WB. STORZ C-MAC video laryngoscope was used on site to conduct intubation training with the Nebraska National Guard. Stallion health technical information. 2011; 163: 80-82.

Hunter I, Ramanathan V, Balasubramanian P, Evans DA, Hardman JG, McCahon RA. The retention of laryngoscopy skills for medical students: a randomized crossover study of Macintosh, AP Advance™, C-MAC and Airtraq® laryngoscopy. anaesthetization. 2016;71(10):1191–1197.

Zaouter C, Calderon J, Hemmerling TM. Video laryngoscopy as a new standard of care. Br J Anaesth. 2014;114(2):181–183.

Aziz MF, Brambrink AM, Healy DW, etc. The success of the intubation rescue technique after the failure of direct laryngoscopy in adults: a retrospective comparative analysis from the multicenter perioperative outcome group. Anesthesiology. 2016;125(4):656–666.

Cook TM, Woodall N, Frerk C; The fourth national audit project. Major complications of British airway management: the results of the fourth national audit project of the Royal College of Anesthesiologists and the Difficult Airway Society. Part 1: Anesthesia. Br J Anaesth. 2011;106(5):617–631.

El-Orbany M, Woehlck H, Mr. Salem. Direct laryngoscopy of the head and neck position. Anesthesia analysis. 2011;113(1):103-109.

Behringer EC, Kristensen MS. Evidence of the benefits and novelty of the new intubation device. anaesthetization. 2011; 66 (Supplement 2): 57-64.

Lyon RM, Perkins ZB, Chatterjee D, Lockey DJ, Russell MQ; Kent, Surrey and Sussex Air Ambulance Trust. Significant improvements to traditional rapid sequence induction have improved the safety and effectiveness of pre-hospital trauma anesthesia. Critical care. 2015; 19:134.

Marsch SC, Steiner L, Bucher E, etc. Succinylcholine and rocuronium for rapid sequential intubation in intensive care: a prospective randomized controlled trial. Critical care. 2011; 15(4): R199.

Natt BS, Malo J, Hypes CD, Sakles JC, Mosier JM. Strategies to improve the success rate of first intubation attempts for critically ill patients. Br J Anaesth. 2016; 117 (Supplement 1): i60-i68.

Hypes CD, Stolz U, Sakles JC, etc. Video laryngoscopy improves the odds of a successful first attempt at intubation in the ICU: propensity matching analysis. Ann Am Thorac Soc. 2016;13(3):382–390.

Chhavi S, Abhyuday K, Parin L. Video laryngoscope as the new standard of trauma ED care. It's J Emerg Med. 2016;34(7):1313–1314.

Sakles JC, Rodgers R, Keim SM. Optical and video laryngoscopes for emergency airway management. Intern emergency medicine. 2008; 3(2): 139–143.

Zaouter C, Calderon J, Hemmerling TM. Video laryngoscopy as a new standard of care. Br J Anaesth. 2015;114(2):181–183.

Karl Storz GmbH & Co. KG, Tuttlingen, Germany. Available from: http://www.karlstorz.de/cps/rde/xchg/SID-E5A329DA-B9AE794B/karlstorz-en/hs.xsl/9549.htm. Visited May 4, 2017.

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and include the Creative Commons Attribution-Non-commercial (unported, v3.0) license. By accessing the work, you hereby accept the terms. The use of the work for non-commercial purposes is permitted without any further permission from Dove Medical Press Limited, provided that the work has an appropriate attribution. For permission to use this work for commercial purposes, please refer to paragraphs 4.2 and 5 of our terms.

Contact Us• Privacy Policy• Associations and Partners• Testimonials• Terms and Conditions• Recommend this site• Top

Contact Us• Privacy Policy

© Copyright 2021 • Dove Press Ltd • Software development of maffey.com • Web design of Adhesion

The views expressed in all articles published here are those of specific authors and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees.

Dove Medical Press is part of Taylor & Francis Group, the academic publishing department of Informa PLC. Copyright 2017 Informa PLC. all rights reserved. This website is owned and operated by Informa PLC ("Informa"), and its registered office address is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 3099067. UK VAT group: GB 365 4626 36

In order to provide our website visitors and registered users with services that suit their personal preferences, we use cookies to analyze visitor traffic and personalize content. You can understand our use of cookies by reading our privacy policy. We also retain data about visitors and registered users for internal purposes and to share information with our business partners. By reading our privacy policy, you can understand which of your data we retain, how to process it, with whom to share it, and your right to delete data.

If you agree to our use of cookies and the content of our privacy policy, please click "Accept".