A comparison of endotracheal intubation characteristics between Macintosh, CMAC, and Smart Trach Video laryngoscope: a randomized prospective clinical trial

ABSTRACT

Background

In this study, we compared the performance characteristics of Macintosh laryngoscope, CMAC videolaryngoscope with a recently developed videolaryngoscope called Smart Trach.

Research design and methods

Three hundred seventy-five patients belonging to mixed population without having anticipated difficult airways undergoing elective surgeries were randomly allocated to be intubated using either of the three laryngoscopes (Macintosh, CMAC, or Smart Trach). Time needed for successful intubation, number of attempts, Cormack Lehane’s (CL) grading, optimization maneuverers, intubation difficulty score (IDS), subjective ease of intubation (VAS), subjective lifting force, and complications were recorded.

Results

Demographic and anthropometric measurements (sex, height, weight, and body mass index) among the groups were comparable. CL grades, lifting force, IDS, VAS, and intubation times (seconds) were significantly different whereas need for maneuver, attempts, and complications was similar (p > 0.05 each). Intubation times (seconds) were significantly different between Macintosh [36(29–43) seconds], CMAC [30(24–37)], and Smart Trach [35(30–42] groups. (p < 0.001). Subjective ease of intubation based on VAS score was lowest in Smart trach group [1(1–2)] (p < 0.001).

Conclusion

Shortest intubation times were achieved with CMAC with least use of lifting force. First attempt success rates of were similar. Intubation was easiest subjectively using Smart Trach as manifested by lowest VAS and IDS.

Trial Registration

Clinical Trial registry of India (CTRI/2019/09/021279 dated 17/09/2019)

KEYWORDS:

• Intubation
• laryngoscopy
• smartphones
• visual analogue scale
• video laryngoscopy

Acknowledgments

Residents and Technologists of Department of Anaesthesiology, SGPGIMS, Lucknow who assisted in the conduct of the study.

Declaration of interest

Ashish Kumar Kannaujia is the developer of the device Smarttrach and has applied for the patent of the same. The other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contributions

Rudrashish Haldar: Conception & design, data collection, analysis & interpretation, drafting & revising, final approval.

Ashish Kumar Kannaujia: Conception and design, conduct of cases, data collection, critical revision

Rafat Shamim: Conduct of the cases, data collection, drafting & revising

Prabhaker Mishra: Analysis & interpretation, critical revision

All authors agree to be accountable for all aspects of the work.

Additional information

Funding

The manuscript was not funded.