Video Laryngoscopy Improves Success Rate of Emergency Tracheal Intubation

TOPLINE:

In critically ill patients, video laryngoscopy offers superior glottic visualization, reduces the incidence of esophageal intubation, and improves the first-attempt success rate of emergency tracheal intubation in hospital but not in prehospital settings.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 26 randomized controlled trials with 5952 critically ill adult patients to assess whether video laryngoscopy can improve the clinical outcomes of emergency tracheal intubation.
• Patients in prehospital or hospital settings,
• Video laryngoscopy was compared with direct laryngoscopy for evaluating the clinical outcomes of emergency tracheal intubation, with the primary outcome being the first-attempt success rate.
• The secondary outcomes included intubation time, glottic visualization, in-hospital mortality, and complications such as esophageal intubation.

TAKEAWAY:

• Video laryngoscopy had higher first-attempt success rates in hospital settings, particularly in the ED (risk ratio [RR], 1.13; P =.007), in the ICU (RR, 1.16; P =.003), and among inexperienced operators (RR, 1.04; P =.35).
• In hospital settings, video laryngoscopy provided better glottic visualization (RR, 1.11; 95% CI, 1.03-1.20) and led to reduced incidence of esophageal intubation (RR, 0.42; 95% CI, 0.24-0.71).
• Conversely, in prehospital settings, video laryngoscopy had a lower first-attempt success rate than direct laryngoscopy (RR, 0.75; 95% CI, 0.57-0.99).
• The overall first-attempt success rate of video laryngoscopy was not significantly different from that of direct laryngoscopy.

IN PRACTICE:

“Although existing guidelines for intubation in critically ill patients acknowledge the advantages of VL and recommend it as the first option for emergency intubations of critically ill patients, these recommendations were not based on previous meta-analyses of RCTs [randomized controlled trials],” the authors wrote. “Our findings support the routine use of VL in EDs [emergency departments] and ICUs [intensive care units], particularly for inexperienced operators,” they added. 

SOURCE:

The study was led by Kai Zhang, Zhejiang University School of Medicine, Second Affiliated Hospital, Hangzhou, China. It was published online on October 2, 2024, in Emergency Medicine Journal.

LIMITATIONS:

Significant heterogeneity was found in the primary outcome, and the effect estimates were inconsistent across the subgroups. The absence of patient-level data prevented a more detailed assessment of the factors influencing the relative efficacy of video vs direct laryngoscopy.

DISCLOSURES:

The study was supported in part by grants from the National Natural Science Foundation of China and the Medical and Health Research Program of Zhejiang Province. No conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.