Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis

Abstract

Videolaryngoscopy (VL) may improve the success of orotracheal intubation compared with direct laryngoscopy (DL). We performed a systematic search of PubMed, Embase, and CENTRAL databases for studies comparing VL and DL for emergency orotracheal intubations outside the operating room. The primary outcome was rate of first-pass intubation, with subgroup analyses by location, device used, clinician experience, and clinical scenario. The secondary outcome was complication rates. Data are presented as [odds ratio (95% confidence intervals); P-values]. We identified 32 studies with 15 064 emergency intubations. There was no difference in first-pass intubation with VL compared with DL [OR=1.28, (0.99-1.65); P=0.06]. First-pass intubations were increased with VL compared with DL in the intensive care unit (ICU) [2.02 (1.43-2.85); P<0.001], and similar in the emergency department or pre-hospital setting. First-pass intubations were similar with GlideScope, but improved with the CMAC [1.32 (1.08-1.62); P=0.007] compared with DL. There was greater first-pass intubation with VL compared with DL amongst novice/trainee clinicians [OR=1.95 (1.45-2.64); P<0.001], but not amongst experienced clinicians or paramedics/nurses. There was no difference in first-pass intubation with VL compared with DL during cardiopulmonary resuscitation or trauma. VL compared with DL was associated with fewer oesophageal intubations [OR=0.32 (0.14-0.70); P=0.003], but more arterial hypotension [OR=1.49 (1.00-2.23); P=0.05]. In summary, VL compared with DL is associated with greater first-pass emergency intubation in the ICU and amongst less experienced clinicians, and reduces oesophageal intubations. However, VL is associated with greater incidence of arterial hypotension. Further trials investigating the utility of VL over DL in specific situations are required.

Video laryngoscopy versus direct laryngoscopy for first-attempt tracheal intubation in the general ward

“…A video laryngoscope, defined as a laryngoscopic device to which a camera has been attached to the tip of the blade, could assist airway management by improving visualisation of the glottis in critically ill patients [ 7 – 10 ]. According to a few studies, video laryngoscopy yields a greater rate of first-attempt intubation success than direct laryngoscopy [ 7 , 11 ]. However, a recent randomised clinical trial in an intensive care unit (ICU) setting found that video laryngoscopy did not yield higher first-attempt tracheal intubation success rate than direct laryngoscopy and was associated with higher rates of complications [ 12 ].…”

Intubation Types among Paramedic and Anesthesia Students

“…It has been argued that ETI proficiency must be obtained by paramedic students using human simulator or training based regardless of the live operating room. Simulated ETI training is included by previous studies before clinical experience [17,18]. Intensive teaching without any distractions of current clinical care is facilitated by simulator/mannequin-based training theoretically to allow for isolated or concentration elements of a skill or process.…”

Pre-hospital advanced airway management: is quality improvement possible? Comment on Br J Anaesth 2018; 120: 1103–9

“…In our study, the majority of airway providers were experienced anaesthesiologists, whereas the majority were non-physicians in the study by Arulkumaran and colleagues. 3 The physician studies in the systematic review used mainly the indirect videolaryngoscopes Glidescope ® or Airtraq ® , whereas in our study direct videolaryngoscopes, for example McGrath ® and C-MAC ® , were mainly used. The McGrath ® direct videolaryngoscope has been associated with a high first pass intubation success rate when used by experienced pre-hospital anaesthesiologists.…”