MACMAN
Trial question
What is the role of video laryngoscopy in ICU patients requiring orotracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 371
371 patients (136 female, 235 male).
Inclusion criteria: ICU patients requiring orotracheal intubation.
Key exclusion criteria: contraindications to orotracheal intubation; insufficient time for randomization; age < 18 years; pregnancy or lactation.
Interventions
N=186 video laryngoscopy (McGrath™ MAC video laryngoscope).
N=185 conventional laryngoscopy (Macintosh direct laryngoscope).
Primary outcome
Proportion of patients with successful first-pass intubation
67.7%
70.3%
70.3 %
52.7 %
35.1 %
17.6 %
0.0 %
Video
laryngoscopy
Conventional
laryngoscopy
No significant
difference ↔
No significant difference in the proportion of patients with successful first-pass intubation (67.7% vs. 70.3%; ARD -2.5, 95% CI -11.9 to 6.9).
Secondary outcomes
Borderline significantly longer time to successful intubation (3 min vs. 3 min).
No significant difference in life-threatening complications (13.3% vs. 9.5%; AD 3.8%, 95% CI -2.7 to 10.4).
Borderline significant increase in mechanical ventilation-free days by day 28 (21 days vs. 19.2 days).
Safety outcomes
No significant difference in mild-to-moderate life-threatening complications and death.
Significant difference in severe life-threatening complications (9.5% vs. 2.8%).
Conclusion
In ICU patients requiring orotracheal intubation, video laryngoscopy was not superior to conventional laryngoscopy with respect to proportion of patients with successful first-pass intubation.
Reference
Jean Baptiste Lascarrou, Julie Boisrame-Helms, Arthur Bailly et al. Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial. JAMA. 2017 Feb 7;317(5):483-493.
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