First-Attempt Intubation Success Rate Using the C-MAC Videolaryngoscope Versus Direct Laryngoscopy Among Anaesthesiology Residents Performing Rapid Sequence Induction: A Randomised Controlled Trial

BACKGROUND AND AIMS: The primary objective of this randomised trial was to compare the first-attempt intubation success rate between the C-MAC videolaryngoscope (VL) and the Macintosh direct laryngoscope (DL) when used by novice anaesthesia residents during rapid sequence induction (RSI). Secondary objectives were to compare intubation time; laryngoscopic view (Cormack-Lehane grade (CLG) and Percentage of Glottic Opening (POGO) score); the need for adjunct manoeuvres and devices (optimal external laryngeal manipulation (OELM), release of cricoid pressure, and use of a gum elastic bougie (GEB)); and the incidence of hypoxia, regurgitation, mucosal or dental injury, and haemodynamic changes during and after intubation. METHODS: This randomised controlled trial included 172 adult patients with normal airways requiring RSI, who were allocated to either the VL group (n = 86) or the DL group (n = 86). Resident anaesthesiologists underwent lecture- and simulation-based training prior to performing intubations in the operating room. RSI and tracheal intubation were performed using the allocated device. The primary endpoint was first-attempt intubation success. Secondary endpoints included intubation time, manoeuvres required for successful intubation, incidence of hypoxia and regurgitation, mucosal or dental injury, and haemodynamic changes during and after intubation. RESULTS: First-attempt intubation success was significantly higher in the VL group compared with the DL group (93% vs 67%, P < 0.001). A CLG 1 view was obtained in 76% of patients in the VL group and 54% in the DL group (P < 0.001). External laryngeal manipulation, release of cricoid pressure, use of a GEB, and dental injuries were significantly lower in the VL group (P < 0.001). Heart rate and systolic blood pressure increased significantly during DL-guided intubation. CONCLUSION: VL-guided intubation by novice anaesthesia residents during RSI was associated with a higher first-attempt success rate and superior laryngoscopic views compared with DL, along with fewer adjunct manoeuvres and airway injuries. These findings support the use of VL as a valuable tool for resident-performed RSI in patients without anticipated difficult airways.