Comparison of Macintosh Direct Laryngoscope with the C-MAC and Tuoren Videolaryngoscopes in Facilitating Endotracheal Intubation during Uninterrupted Manual Chest Compression: A Randomized Crossover Manikin Study

Background: Videolaryngoscopes (VLS) frequently provide superior views of the glottis compared with traditional direct laryngoscopy (DL), especially during unexpected difficult airways. Chest compressions during attempts to intubate the trachea make it a difficult situation. Although VLS have been compared with DL for intubation during resuscitation, there is a paucity of literature comparing VLS with integrated screen and distant screen with DL during continued manual chest compressions. Materials and methods: This was a prospective, randomized, crossover observational manikin study. A total of 20 participants performed intubation, while manual chest compression was continuing, with each of the three devices on six occasions, but in different, randomized order. The primary outcome parameter was the total time taken for successful intubation. The secondary outcome criteria included the number of attempts, ease of intubation, and the device preference. Results: Time taken for successful intubation and ease of intubation were significantly better with C-MAC VLS and DL as compared with Tuoren VLS (C-MAC vs Tuoren p < 0.000 for both; DL vs Tuoren p < 0.001 for time and p = 0.021 for ease). There was no significant difference between C-MAC and DL (p = 1.0 for time and p = 0.69 for ease). There was no significant difference with regard to the number of attempts for successful intubation with any of these devices (p = 0.310). C-MAC was the most and Tuoren was the least preferred device. Conclusion: C-MAC VLS and Macintosh DL are significantly easier to use and require significantly less time to achieve successful intubation as compared with the Tuoren VLS during continued manual chest compression. Among the devices tested, C-MAC VLS was the most preferred for endotracheal intubation during uninterrupted manual chest compressions.