{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:36:45Z","timestamp":1787812605409,"version":"build-2784847793"},"reference-count":27,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,22]],"date-time":"2020-08-22T00:00:00Z","timestamp":1598054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Endotracheal intubation (ETI) with direct view laryngoscopy (DL) is the gold standard for airway management. Videolaryngoscopy (VL) can improve glottis visualization, thus facilitating ETI. The aim of this monocentric, randomized, prospective study on a physician staffed German air ambulance is to compare DL and VL for ETI in terms of number of attempts and time as well as visualization of the glottis in a prehospital setting in a physician-based rescue system in adult patients. A power analysis was performed \u00e0 priori. We used consecutive on-scene randomization with a sealed envelope system for the DL and VL-group. Successful ETI with first pass success was significantly more frequent with VL than DL and three seconds faster. The percentage of glottis opening and the Cormack &amp; Lehane classification were significantly better with VL than DL. Regarding improved first pass success in ETI with the VL, we would recommend the use of VL for prehospital airway management in physician-based rescue systems.<\/jats:p>","DOI":"10.3390\/jcm9092719","type":"journal-article","created":{"date-parts":[[2020,8,23]],"date-time":"2020-08-23T21:28:06Z","timestamp":1598218086000},"page":"2719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Increased First Pass Success with C-MAC Videolaryngoscopy in Prehospital Endotracheal Intubation\u2014A Randomized Controlled Trial"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8711-5182","authenticated-orcid":false,"given":"Christian","family":"Macke","sequence":"first","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Gralla","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Winkelmann","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Dierk","family":"Clausen","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Haertle","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Krettek","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Omar","sequence":"additional","affiliation":[{"name":"Trauma Department, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1097\/CCM.0b013e31817d7ae1","article-title":"The difficult airway in adult critical care","volume":"36","author":"Lavery","year":"2008","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1034\/j.1399-6576.2001.045003327.x","article-title":"A survey of tracheal intubation difficulty in the operating room: A prospective observational study","volume":"45","author":"Adnet","year":"2001","journal-title":"Acta Anaesth. Scand."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1213\/01.ane.0000253523.80050.e9","article-title":"The Out-Of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians","volume":"104","author":"Timmermann","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/ALN.0000000000001267","article-title":"Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults: A Retrospective Comparative Analysis from the Multicenter Perioperative Outcomes Group","volume":"125","author":"Aziz","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13049-019-0599-1","article-title":"Airway Management in the Emergency Department (The OcEAN-Study)-A prospective single centre observational cohort study","volume":"27","author":"Bernhard","year":"2019","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s40814-019-0433-6","article-title":"A single-centre, randomised controlled feasibility pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients","volume":"5","author":"Loughnan","year":"2019","journal-title":"Pilot Feasibility Stud."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/bja\/aex228","article-title":"Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: A Cochrane Systematic Review","volume":"119","author":"Lewis","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1111\/anae.14057","article-title":"Videolaryngoscopy vs. direct laryngoscopy use by experienced anaesthetists in patients with known difficult airways: A systematic review and meta-analysis","volume":"72","author":"Pieters","year":"2017","journal-title":"Anaesthesia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e470","DOI":"10.1097\/CCM.0000000000001669","article-title":"Use of the glidescope ranger video laryngoscope for emergency intubation in the prehospital setting: A Randomized Control Trial","volume":"44","author":"Trimmel","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1097\/CCM.0000000000003918","article-title":"Comparing the McGrath Mac Video Laryngoscope and Direct Laryngoscopy for Prehospital Emergency Intubation in Air Rescue Patients","volume":"47","author":"Kreutziger","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1213\/ANE.0000000000002735","article-title":"Faculty Opinions recommendation of Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter Comparison of Different Blade Types Using A.P. Advance, C-MAC System, and KingVision","volume":"126","author":"Cavus","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/s00101-019-0562-6","article-title":"Preclinical emergency anesthesia: A current state analysis from 2015\u20132017","volume":"68","author":"Luckscheiter","year":"2019","journal-title":"Anaesthesist"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.bja.2017.11.014","article-title":"Universal videolaryngoscopy: A structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department","volume":"120","author":"Cook","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/j.bja.2018.02.029","article-title":"Education: The last mile to universal videolaryngoscopy","volume":"120","author":"Wu","year":"2018","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/1742-6723.12704","article-title":"Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care","volume":"29","author":"Park","year":"2016","journal-title":"Emerg. Med. Australas."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/ALN.0b013e3182023eb7","article-title":"Routine Clinical Practice Effectiveness of the Glidescope in Difficult Airway Management","volume":"114","author":"Aziz","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/acem.12055","article-title":"The importance of first pass success when performing orotracheal intubation in the emergency department","volume":"20","author":"Sakles","year":"2013","journal-title":"Acad. Emerg. Med."},{"key":"ref_18","first-page":"1","article-title":"Abstract 4: Predictors of Definitive Airway sans Hypoxia\/Hypotension on First Attempt (DASH 1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation","volume":"7","author":"Powell","year":"2019","journal-title":"Prehosp. Emerg. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2303","DOI":"10.1001\/jama.2019.18254","article-title":"Effect of Rocuronium vs Succinylcholine on Endotracheal Intubation Success Rate Among Patients Undergoing Out-of-Hospital Rapid Sequence Intubation: A Randomized Clinical Trial","volume":"322","author":"Guihard","year":"2019","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Min, B.C., Park, J.E., Lee, G.T., Kim, T., Yoon, H., Cha, W.C., Shin, T.G., Song, K.J., Park, M., and Han, H. (2019). C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation. Medicina, 55.","DOI":"10.3390\/medicina55060225"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.amj.2019.06.004","article-title":"First-Pass Success Intubations Using Video Laryngoscopy Versus Direct Laryngoscopy: A Retrospective Prehospital Ambulance Service Study","volume":"38","author":"Eberlein","year":"2019","journal-title":"Air Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/1742-6723.13329","article-title":"Effect of the introduction of C-MAC videolaryngoscopy on first-pass intubation success rates for emergency medicine registrars","volume":"32","author":"Mackie","year":"2019","journal-title":"Emerg. Med. Australas."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1093\/bja\/61.2.211","article-title":"Predicting Difficult Intubation","volume":"61","author":"Wilson","year":"1988","journal-title":"Br. J. Anaesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1111\/j.1365-2044.2011.06872.x","article-title":"Performance of the C-MAC video laryngoscope in patients after a limited glottic view using Macintosh laryngoscopy","volume":"66","author":"Piepho","year":"2011","journal-title":"Anaesthesia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1097\/EJA.0000000000000525","article-title":"C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department","volume":"33","author":"Sulser","year":"2016","journal-title":"Eur. J. Anaesth."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.annemergmed.2015.06.006","article-title":"Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation","volume":"67","author":"Bodily","year":"2016","journal-title":"Ann. Emerg. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s00101-015-0051-5","article-title":"Comparison of five video laryngoscopes and conventional direct laryngoscopy: Investigations on simple and simulated difficult airways on the intubation trainer","volume":"64","author":"Ruetzler","year":"2015","journal-title":"Anaesthesist"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:05:17Z","timestamp":1760177117000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,22]]},"references-count":27,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9092719"],"URL":"https:\/\/doi.org\/10.3390\/jcm9092719","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,22]]}}}