Original ContributionC-MAC videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis
Introduction
In the last decade, videolaryngoscopy has become widely used and various types of devices are now available. The C-MAC laryngoscope (C-MAC) (Karl Storz, Tuttlingen, Germany) is one of several videolaryngoscopes consisting of a modified Macintosh blade without a tube-guiding stylet, a portable high-resolution liquid-crystal display monitor unit, and an electronic module that transfers to the monitor unit the glottic image obtained from a digital camera located laterally in the distal third of the blade [1].
In some anecdotal reports, it is reported that the C-MAC has a higher success rate, a shorter intubation time, and a better view of the glottis than the Macintosh laryngoscope during tracheal intubation. [2] [3] However, in other reports, it is reported that the C-MAC has similar efficacy to the Macintosh laryngoscope for tracheal intubation. [4] [5] [6].
A recent meta-analysis comparing the videolaryngoscope and direct laryngoscope for tracheal intubation was published in 2016 [7]. The analysis showed that the success rates of tracheal intubation with the C-MAC was significantly higher compared to the Macintosh laryngoscope, with a relative risk (RR) of 0.32 and 95% confidence interval (CI) 0.15–0.68. However, there were only eight studies included in this meta-analysis. In addition, this meta-analysis included not only the C-MAC (five trials) but also the V-MAC laryngoscope (three trials). Moreover, these studies did not compare the intubation time, glottic visualisation, or number of external laryngeal manipulations (ELM) between the C-MAC and the Macintosh laryngoscope.
In this study, we performed a systematic review and meta-analysis of several randomised controlled trials to compare the utility of the C-MAC with that of the Macintosh laryngoscope for tracheal intubation in the adult population. The aim of this study is to examine success rates, intubation time, glottic visualisation, and number of ELM to determine whether the C-MAC is superior to the Macintosh laryngoscope for tracheal intubation in the adult population. Moreover, we conducted a subgroup analysis to investigate the effect of airway condition (normal airway or difficult airway) and laryngoscopist's experience level (novice or experienced) performing the tracheal intubation.
Section snippets
Materials and methods
This quantitative systematic review was performed according to the criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [8]. First, we established the analysis methods and set the inclusion and exclusion criteria used in this meta-analysis, and then registered the study protocol in the UMIN Clinical Trials Registry (registration number: UMIN 000023694; principal investigator's name: H. Hoshijima; date of registration: 19 August 2016).
Characteristics of studies included in the meta-analysis
Our search of electronic databases initially identified 322 articles for review. Of these, 271 studies were excluded because they were comparisons between unrelated laryngoscopes, or were unrelated studies. The remaining 51 articles were thoroughly examined to determine whether they met our inclusion criteria. Of these, 35 studies were excluded because they were not randomised controlled trials (n = 17) or manikin trials (n = 11), or review articles (n = 3), or pediatric trials (n = 2) or
Explanation of results
The results of our meta-analysis suggest that the C-MAC offers superior glottis visualisation and less ELM compared with the Macintosh laryngoscope, but showed no advantages in success rates and intubation time. However, in difficult airway settings, the C-MAC offers higher success rates for tracheal intubation and provides better visualisation of the glottis compared with the Macintosh laryngoscope. The C-MAC did not prevent intubation-related adverse events.
Superior glottic visualisation is
Conflicts of interest
We have no conflicts of interest.
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