OBJECTIVES:

Intubation with a Macintosh blade is a routine procedure in perioperative care and evidence demonstrates that video laryngoscopy (VL) improves intubation success versus direct laryngoscopy (DL). We wish to understand the type of health-economic analysis required to inform purchasing decisions between the two common VL devices, C-MAC and McGrath MAC.

METHODS:

We reviewed the studies included in a 2022 Cochrane review comparing VL versus DL. Only studies that used McGrath MAC VL or C-MAC VL compared with Macintosh DL in perioperative care were selected. Outcomes assessed were first-pass success (FPS), failed intubation, and esophageal intubation. Meta-analyses were performed using RevMan 5.4. Failed and esophageal intubations as rare events were assessed using the Peto odds ratio (OR). The risk ratio (RR) was used for FPS. The Metafor R package for comparing estimates of independent meta-analyses was used to assess whether the outcomes for McGrath MAC and C-MAC were statistically different.

RESULTS:

FPS was significantly improved using either VL in comparison to DL: RR 1.07 [95% confidence interval 1.01,1.15] for McGrath MAC and RR 1.04 [1.00,1.09] for C-MAC. Failed intubations were significantly decreased: OR 0.33 [0.12, 0.92] for McGrath MAC and OR 0.37 [0.18, 0.77] for C-MAC. There was no significant difference between meta-analyses for McGrath MAC and C-MAC for both outcomes. A non-significant reduction for esophageal intubation was identified for McGrath MAC with OR 0.23 [0.04, 1.15], however, no overall effect could be estimated for C-MAC.

CONCLUSIONS:

No difference in clinical efficacy was determined between McGrath MAC and C-MAC although their superiority to DL was confirmed. A cost-minimization analysis is likely sufficient to inform purchasing decisions, where the purchase cost could present a key factor when choosing a device without compromising patient safety.