Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients–a systematic review and meta-analysis

Abstract

Objective: This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients. Methods: The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study. Results: Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very lowquality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03). Conclusions: Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.

Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department

“…The mortality in our collective was much higher compared to major trauma patients in the German Trauma Registry but especially mean age differs between the trauma registry patients and our collective [9]. Overall, airway management in the ED is a current eld of clinical research although outcome data is mostly not available [4,10,11]. A mean ED treatment phase of 148.2 min in our collective points out that this concept led to relevant resource consumption.…”

Impact of aerosol box on intubation during COVID-19: a simulation study of normal and difficult airways

“…For comparative purposes, traditional methods were also used. 16 , 18 Results from the robust RM-ANOVA indicated there was significant difference for use of the aerosol box: P = 0.03, = 0.03, 95% confidence interval (CI), 0.00 to 0.23. Note that for (generalized eta squared), the effect sizes are 0.02 = small, 0.13 = medium, and 0.26 = large.…”

“…An effect size (0.25) was chosen based on lower estimates of effect sizes for adverse events during tracheal intubation using video and direct laryngoscopes. 16 The necessary sample size was determined to be 36.…”

Erweiterte lebensrettende Maßnahmen für Erwachsene

“…Videolaryngoskope werden zunehmend in der klinischen Anästhesie und intensivmedizinischen Praxis eingesetzt [ 294 , 295 ]. Vorläufige Studien zeigen, dass die Videolaryngoskopie während der CPR im Vergleich zur direkten Laryngoskopie die Larynxsicht und die Erfolgsrate der Intubation verbessert [ 296 , 297 ], das Risiko von Ösophagusintubationen verringert [ 298 ] sowie Unterbrechungen der Thoraxkompressionen reduziert [ 299 ]. Eine systematische Überprüfung ergab, dass die Videolaryngoskopie durch erfahrene Anwender im präklinischen Umfeld den Intubationserfolg beim ersten Versuch (RR 0,57; P < 0,01; qualitativ hohe Evidenz) und die Gesamterfolgsrate verringerte (RR 0,58; 95 %-CI 0,48–0,69; mäßige Evidenz) [ 300 ].…”