Evgenia Dimou, Diamanto Aretha, Theano Beskou-Kontou, Antonis Kostouros, Matthaios Pappas, Angeliki Panagopoulou, Theodoros Xanthos
Nine studies met the inclusion criteria. The evidence base comprised six adult clinical patient studies and three manikin-based airway studies. Adult clinical patient studies and manikin-based studies were reported separately, and manikin datasets were not counted as clinical patients. Six adult clinical patient studies were included in the quantitative meta-analysis, whereas manikin-based studies were summarized qualitatively. No definitive superiority of either device was demonstrated for first-pass intubation success in adult clinical patients. C-MAC showed shorter intubation time in some analyses, but heterogeneity was substantial, and certainty of evidence was limited.
INTRODUCTION: Videolaryngoscopes are widely utilized in daily clinical practice within anesthesiology and emergency medicine to enhance airway management techniques and promote patient safety. Among these devices, the C-MAC and McGrath videolaryngoscopes have been extensively evaluated in multiple studies to determine their relative efficacy. This systematic review aims to synthesize the findings of available research comparing the C-MAC and McGrath with respect to first-pass intubation success and intubation time, as well as to conduct a meta-analysis for statistical evaluation.
MATERIALS AND METHODS: A systematic review was performed using PubMed, Scopus, Cochrane Library, and Google Scholar in accordance with PRISMA guidelines. Eligible studies directly compared the C-MAC and McGrath videolaryngoscopes in adult clinical patients, simulated-patient clinical scenarios, or adult manikin-based airway models. Because these populations are methodologically and clinically heterogeneous, adult clinical patient studies were strictly separated from simulated-patient and manikin studies. Quantitative meta-analysis was restricted to adult clinical patient studies, whereas simulated-patient and manikin studies were summarized qualitatively. Studies were screened up to June 23, 2025, and assessed for bias with the Cochrane Risk of Bias 2.0 tool. Results are summarized in tables, and meta-analysis was conducted using R (meta-package, V4.4.1), focusing on first-pass intubation success and intubation time, displayed as forest plots. Certainty of evidence for the main outcomes was assessed using a GRADE-based approach, while publication bias and sensitivity analyses were also performed.
RESULTS: Nine studies met the inclusion criteria. The evidence base comprised six adult clinical patient studies and three manikin-based airway studies. Adult clinical patient studies and manikin-based studies were reported separately, and manikin datasets were not counted as clinical patients. Six adult clinical patient studies were included in the quantitative meta-analysis, whereas manikin-based studies were summarized qualitatively. No definitive superiority of either device was demonstrated for first-pass intubation success in adult clinical patients. C-MAC showed shorter intubation time in some analyses, but heterogeneity was substantial, and certainty of evidence was limited.
DISCUSSION: The available evidence should be interpreted cautiously because of clinical heterogeneity, differences in airway difficulty, operator experience, device blade configuration, and outcome definitions. Simulated-patient and manikin-based airway studies provide useful information on device handling and training but should not be interpreted as directly equivalent to adult clinical patient evidence.