Video Versus Direct Laryngoscopy for Intubation: Updated Systematic Review and Meta-Analysis

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Emergency Medicine

Background:

• Direct laryngoscopy (DL) is a standard method for endotracheal intubation (EI).
• Video laryngoscopy (VL) offers enhanced glottic visualization via a screen, aiding endotracheal tube (ETT) placement.
• Both DL and VL are utilized in emergency and critical care settings for airway management.

Purpose of the Study:

• To compare the efficacy of DL and VL in achieving first-attempt tracheal intubation in critically ill patients.
• To assess the safety profiles of DL and VL by comparing rates of severe hypoxemia, hypotension, and cardiac arrest.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies published until 2023.
• Searched databases included PubMed, EMBASE, and Scopus.
• Included studies focused on critically ill patients undergoing EI with either DL or VL, with first-attempt success as the primary outcome.

Main Results:

• Analysis of eight studies involving 5348 patients (1780 DL, 3568 VL) showed a significantly higher first-attempt intubation success rate with VL (81.5%) compared to DL (68%).
• No significant difference was found in the rates of severe hypoxemia, severe hypotension, or cardiac arrest between VL and DL groups.
• The meta-analysis confirmed VL's superiority in first-pass intubation success without an increase in adverse events.

Conclusions:

• Video laryngoscopy demonstrates a higher success rate for first-attempt endotracheal intubation in critically ill patients compared to direct laryngoscopy.
• VL is associated with comparable safety outcomes to DL, with no increased risk of severe adverse events.
• VL is a valuable tool for improving airway management outcomes in emergency and critical care settings.