Video laryngoscopy improves the success rate of emergency tracheal intubation

TOPLINE:

In critically ill patients, videolaryngoscopy provides better glottic visualization, reduces the incidence of esophageal intubation, and improves the success rate of emergency tracheal intubation on the first attempt in the hospital, but not in the prehospital setting.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 26 randomized controlled trials involving 5,952 critically ill adult patients to assess whether videolaryngoscopy can improve the clinical outcomes of emergency tracheal intubation.
• Patients in the preclinical or hospital area,
• Video laryngoscopy was compared with direct laryngoscopy to evaluate the clinical outcomes of emergency tracheal intubation, with the primary outcome being the first attempt success rate.
• Secondary endpoints included intubation time, glottic visualization, in-hospital mortality, and complications such as esophageal intubation.

TAKE AWAY:

• Videolaryngoscopy had higher first-attempt success rates in the hospital setting, particularly in the emergency department (risk ratio). [RR]1.13; P =.007), in the intensive care unit (RR, 1.16; P =.003) and among inexperienced operators (RR, 1.04; P =.35).
• In the hospital setting, videolaryngoscopy provided better glottic visualization (RR 1.11; 95% CI 1.03-1.20) and led to a lower incidence of esophageal intubation (RR 0.42; 95% CI 0.24-0, 71).
• Conversely, in the prehospital setting, 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 recognize the benefits of VL and recommend it as a first option for emergency intubation of critically ill patients, these recommendations were not based on previous meta-analyses of RCTs [randomized controlled trials]” wrote the authors. “Our results support the routine use of VL in EDs.” [emergency departments] and intensive care units [intensive care units]especially for inexperienced operators,” they added.

SOURCE:

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

RESTRICTIONS:

Significant heterogeneity was found in the primary endpoint and effect estimates were inconsistent across subgroups. The lack of patient-level data prevented a more detailed assessment of the factors affecting the relative effectiveness of video laryngoscopy compared with 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 as part of this process using multiple editorial tools, including AI. Human editors reviewed this content before publication.