Effect of the introduction of C-MAC videolaryngoscopy on first-pass intubation success rates for emergency medicine registrars.
OBJECTIVES
The present study investigated the impact of introducing C-MAC videolaryngoscopy as the standard method of visualising glottic structures on first-pass intubation success of emergency medicine (EM) registrars in a large tertiary academic hospital in New Zealand.


METHODS
In this retrospective cohort study, all patients receiving attempted orotracheal intubation in Auckland City Hospital ED 1 year prior to and 1 year after the introduction of C-MAC videolaryngoscopy were compared. The primary outcome was first-pass intubation success rates by EM registrars. Secondary outcomes were first-pass success rates by all intubators, and incidence of any complication of intubation.


RESULTS
There were 163 intubations by EM registrars from June 2015 to August 2017. There was a clinically important and statistically significant improvement in first-pass success from 59.2% (95% confidence interval [CI] 44.1-68.8%) to 85.1% (95% CI 76.0-91.2%, P < 0.001) after the introduction of C-MAC. In multivariate analysis, the independent predictors of success were: Airway Not Predicted Difficult, odds ratio (OR) 2.49 (95% CI 1.06-5.85, P = 0.037); and use of videolaryngoscope, OR 4.49 (95% CI 1.85-10.91, P = 0.001). Overall, complications of intubation improved significantly after introduction of C-MAC (28.9%, 95% CI 19.9-40.0% prior to C-MAC introduction; 16.1%, 95% CI 9.7-25.3% after; P = 0.048).


CONCLUSION
This is the first published study specifically addressing EM registrar intubation success rates in New Zealand, adding to the existing body of data suggesting that videolaryngoscopy may improve success rates for novice intubators.
['Mackie|Stephanie|S|0000-0002-4688-3588', 'Moy|Fen|F|', 'Kamona|Sinan|S|', 'Jones|Peter|P|0000-0003-1560-1186']
D000328:Adult D002983:Clinical Competence D004635:Emergency Medicine D004636:Emergency Service, Hospital D005260:Female D006801:Humans D007442:Intubation, Intratracheal D007828:Laryngoscopy D008297:Male D008875:Middle Aged D009520:New Zealand D012189:Retrospective Studies D014741:Video Recording
intubation emergency medicine human intratracheal laryngoscope patient safety