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. 2025 Mar;29(3):208-214.
doi: 10.5005/jp-journals-10071-24934. Epub 2025 Feb 28.

Evaluation of MACOCHA Score for Predicting Difficult Intubation in Critically Ill Cancer Patients: A Prospective Observational Study

Atul P Kulkarni  1 , Shilpushp J Bhosale  1 , Kushal R Kalvit  2 , Swapna Cherian  1 , Anjana M Shrivastava  1 , Manoj R Gorade  3
Affiliations

Evaluation of MACOCHA Score for Predicting Difficult Intubation in Critically Ill Cancer Patients: A Prospective Observational Study

Atul P Kulkarni et al. Indian J Crit Care Med. 2025 Mar.

Abstract

Introduction: Tracheal intubation (TI) is often needed in the intensive care unit (ICU) but can have disastrous consequences. The MACOCHA score was developed for prediction of difficult intubation (DI) in critically ill.

Material and methods: After Institutional Ethics Committee approval, we conducted this prospective, single-center observational study. Evaluated the ability of MACOCHA score to predict difficult intubation in our ICU. We included 500 adults undergoing TI in our ICU. We collected the demographic data, details of ICU admission, and intubation-related data for calculating MACOCHA score. We used Statistical Package for the Social Sciences (version 21) for analysis. The accuracy of MACOCHA score for predicting DI was determined by area under the receiver operating characteristic (AUROC) curve. The Hosmer-Lemeshow goodness-of-fit statistics was used to determine calibration.

Results: Since complete dataset was available for 449/500 patients, we analyzed their data. Acute renal failure and shock were the most frequent reasons for TI. Ketamine and rocuronium were most commonly used drugs for TI. The incidence of DI was 13.5% (60/449). There were 30 patients whose Mallampati score was either III and IV, while 84 and 45 patients had severe hypoxemia and coma before TI, respectively. The AUROC curve for the MACOCHA score was 0.659 (confidence interval, 0.574-0.743), suggesting a moderate discrimination. The Hosmer-Lemeshow goodness-of-fit test showed moderate calibration (χ2 = 3.142, with p = 0.208). One hundred and seventy-one (26.5%) complications occurred in the entire cohort. Some patients had multiple complications.

Conclusion: The MACOCHA score showed moderate discrimination and calibration in predicting DI in our study.

How to cite this article: Kulkarni AP, Bhosale SJ, Kalvit KR, Cherian S, Shrivastava AM, Gorade MR. Evaluation of MACOCHA Score for predicting Difficult Intubation in Critically Ill Cancer Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(3):208-214.

Keywords: Critically ill patients; Difficult intubation; Hypoxia; MACOCHA score; Severe cardiovascular collapse.

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Conflict of interest statement

Source of support: Nil Conflict of interest: Dr Atul P Kulkarni is associated as the Editor-in-Chief of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of the Editor-in-Chief and his research group.Conflict of interest: Dr Atul P Kulkarni is associated as the Editor-in-Chief of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of the Editor-in-Chief and his research group.

Figures

Fig. 1
Fig. 1
The MACOCHA score and incidence of DI
Fig. 2
Fig. 2
The ROC curve for MACOCHA score
See this image and copyright information in PMC

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