For a study published in the New England Journal of Medicine, Matthew Prekker, MD, MPH, and colleagues conducted a multicenter randomized trial to determine whether video laryngoscopy or direct laryngoscopy was more effective for achieving successful tracheal intubation on the first attempt among critically ill adults. The study included 1,417 patients from 17 EDs and ICUs, 91.5% of whom were intubated by an emergency medicine resident or a critical care fellow.
Patients were randomly assigned to either the video-laryngoscope group or the direct laryngoscope group. Successful intubation on the first attempt served as the primary outcome. The occurrence of severe complications during intubation was a secondary outcome.
The trial was stopped early due to the clear efficacy demonstrated during the preplanned interim analysis, according to the study results. In the final analysis, 85.1% of patients in the video-laryngoscope group achieved successful intubation on the first attempt compared with 70.8% of patients in the direct laryngoscope group. This represented a significant absolute risk difference of 14.3 percentage points, indicating a higher success rate with video laryngoscopy (P<0.001).
The researchers reported no significant difference in severe complications during intubation between the two groups. Severe complications, including severe hypoxemia, severe hypotension, increased vasopressor use, cardiac arrest, or death, occurred in 21.4% of the video-laryngoscope group and 20.9% of the direct-laryngoscope group. The absolute risk difference for severe complications was only 0.5 percentage points (95% CI, -3.9 to 4.9).
Safety outcomes, including esophageal intubation, tooth injury, and aspiration, were similar between the two groups, indicating no significant variation in these complications.
“Among critically ill adults undergoing tracheal intubation in an [ED] or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope,” Dr. Prekker and colleagues wrote. ©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.
