+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

First-Attempt Intubation Success of Video Laryngoscopy in Patients with Anticipated Difficult Direct Laryngoscopy: A Multicenter Randomized Controlled Trial Comparing the C-MAC D-Blade Versus the GlideScope in a Mixed Provider and Diverse Patient Population



First-Attempt Intubation Success of Video Laryngoscopy in Patients with Anticipated Difficult Direct Laryngoscopy: A Multicenter Randomized Controlled Trial Comparing the C-MAC D-Blade Versus the GlideScope in a Mixed Provider and Diverse Patient Population



Anesthesia and Analgesia 122(3): 740-750



Intubation success in patients with predicted difficult airways is improved by video laryngoscopy. In particular, acute-angle video laryngoscopes are now frequently chosen for endotracheal intubation in these patients. However, there is no evidence concerning whether different acute-angle video laryngoscopes can be used interchangeably in this scenario and would allow endotracheal intubation with the same success rate. We therefore tested whether first-attempt intubation success is similar when using a newly introduced acute-angle blade, that is an element of an extended airway management system (C-MAC D-Blade) compared with a well-established acute-angle video laryngoscope (GlideScope). In this large multicentered prospective randomized controlled noninferiority trial, patients requiring general anesthesia for elective surgery and presenting with clinical predictors of difficult laryngoscopy were randomly assigned to intubation using either the C-MAC D-Blade or the GlideScope video laryngoscope. The hypothesis was that first-attempt intubation success using the new device (D-Blade) is no >4% less than the established device (GlideScope), which would determine noninferiority of the new instrument versus the established instrument. The secondary outcomes we observed included intubation success with multiple attempts and airway-related complications within 7 days of enrollment. Eleven hundred patients were randomly assigned to either video laryngoscope. Intubation success rate on first attempt was 96.2% in the GlideScope group and 93.4% in the C-MAC D-Blade group. Although the absolute difference between the 2 groups was only 2.8%, the 90.35% upper confidence limit of the difference exceeded the predefined margin (4.98%), indicating a rejection of the noninferiority hypothesis for first-attempt intubation success. For attending anesthesiologists, and upon multiple attempts, intubation success did not differ between systems. Pharyngeal injury was noted in 1% of the patients, and the incidence did not differ between interventional groups. Head-to-head comparison in this large multicenter trial revealed that the newly introduced C-MAC D-Blade does not yield the same first-attempt intubation success as the GlideScope in patients with predicted difficult laryngoscopy except in the hands of attending anesthesiologists. Additional research would be necessary to identify potential causes for this difference. Intubation success rates were very high with both systems, indicating that acute-angle video laryngoscopy is an exceptionally successful strategy for the initial approach to endotracheal intubation in patients with predicted difficult laryngoscopy.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 057881986

Download citation: RISBibTeXText

PMID: 26579847

DOI: 10.1213/ane.0000000000001084


Related references

First-Attempt Intubation Success of Video Laryngoscopy in Patients With Anticipated Difficult Direct Laryngoscopy. Survey of Anesthesiology 60(4): 149-150, 2016

First-Attempt Intubation Success of Video Laryngoscopy in Patients with Anticipated Difficult Direct Laryngoscopy. Anesthesia & Analgesia 122(3): 740-750, 2016

Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial. Anesthesia and Analgesia 2019, 2019

Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial. Critical Care Medicine 43(3): 636-641, 2015

Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simulation in Healthcare 4(3): 160-165, 2009

A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department. Academic Emergency Medicine 16(9): 866-871, 2009

Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope. European Journal of Anaesthesiology 27(1): 24-30, 2010

Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Canadian Journal of Anaesthesia 59(1): 41-52, 2012

Efficacy of Video Laryngoscopy vs. Direct Laryngoscopy During Urgent Endotracheal Intubation: A Randomized Controlled Trial. Chest Journal 144(4): 580a-580b, 2013

Comparison of GlideScope Video Laryngoscopy to Direct Laryngoscopy for Intubation of Pediatric Patients in the Emergency Department. Annals of Emergency Medicine 62(4): S75-S76, 2013

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial. JAMA 317(5): 483-493, 2017

Video laryngoscopy versus direct laryngoscopy for first-attempt tracheal intubation in the general ward. Annals of Intensive Care 8(1): 83, 2018

Comparison of C-MAC Videolaryngoscope, GlideScope Ranger and conventional laryngoscopy for tracheal intubation in patients with a predicted difficult airway - A randomized controlled trial. European Journal of Anaesthesiology 27: 263-264, 2010

Video-laryngoscopy versus direct laryngoscopy in critically ill patients: a pilot randomized trial. Canadian Journal of Anaesthesia 59(11): 1032-1039, 2012

Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates. Anesthesia and Analgesia 129(2): 482-486, 2019