The Video Classification of Intubation (VCI) score for videolaryngoscopy: a multicentre international feasibility...

A universally accepted standard of communication for tracheal intubation using videolaryngoscopy is yet to be established. This international multicentre study aimed to assess the reliability of documenting paired, simultaneous Video Classification of Intubation (VCI) scores for individual tracheal intubation events in diverse clinical settings.

In November 2021, an open invitation was issued to join the VCI project. For selected tracheal intubations using videolaryngoscopy during routine care, two airway-competent clinical staff independently recorded a VCI score. One was the healthcare professional performing the tracheal intubation, and the other was an observer present during the procedure. Data were collected over a 41-month period via a secure, password-protected online database.

Between November 2021 and April 2025, 1644 paired VCI scores were submitted from 18 institutions across four countries. A Krippendorff alpha score of 0.858 (95% confidence interval 0.839-0.878) was obtained for the composite VCI score. The percentage agreement between the intubator-observer pairs for the composite VCI score was 89.1% (n=1465).

The VCI score exhibits high inter-rater reliability across a wide range of clinical settings and patient populations, among airway-competent clinical staff of diverse experience and backgrounds. This study highlights the potential of the VCI score to standardise communication of tracheal intubation using videolaryngoscopy, thereby contributing to improved patient safety and quality of care.