Endotracheal intubation in a medical transport helicopter - comparing direct laryngoscopy with the prototype Storz CMAC videolaryngoscope in a simulated difficult intubating position.

This pilot study examined backward intubation of the Laerdal Difficult Airway Manikin in a medical transport helicopter using the prototype (a new more compact) Storz CMAC videolaryngoscope. The standard manikin airway Cormack Lehane (CL) view scores were 2.00 +/- 1.00 for direct view and 1.375 +/- 0.517 for the indirect view (CMAC). Success rates for backward intubation in the standard airway were 100% (CMAC) and 87.5% (DV). Average CL grades in the difficult airway were 3.63 +/- 0.74 (DV) and 2.00 +/- 0.926 (CMAC)(p = 0.002). The success rates for backward intubation of the difficult airway were 12.5% (DV) and 63% (CMAC). Our results show that in backward intubation of the difficult airway in a helicopter setting, the prototype CMAC videolaryngoscope significantly improved the airway score by 1-2 grades and improved intubation success 5-fold. Studies using the portable CMAC videolaryngoscope under challenging rescue conditions and positions should be considered.