The use of video laryngoscopy for tracheal intubation has increased over time. It is unclear how the results of this approach compare with those of direct laryngoscopy.
Background
It is not known whether videolaryngoscopy compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt in critically ill adults.
Methods
In a multicenter randomized trial conducted in 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video laryngoscope group or the direct laryngoscope group.
The primary outcome was successful intubation on the first attempt.
The secondary outcome was the occurrence of serious complications during intubation; Serious complications were defined as severe hypoxemia, severe hypotension, new or increased use of vasopressors, cardiac arrest, or death.
Results
The trial was stopped for efficacy at the time of the single preplanned interim analysis.
Among the 1,417 patients included in the final analysis (91.5% of whom underwent intubation performed by an emergency medicine resident or critical care fellow), successful intubation on the first attempt occurred in 600 of 705 patients (85.1%) in the videolaryngoscope group and in 504 of 712 patients (70.8%) in the direct laryngoscope group (absolute risk difference, 14.3 percentage points; confidence interval [ 95% CI, 9.9 to 18.7, P < 0.001).
A total of 151 patients (21.4%) in the videolaryngoscope group and 149 patients (20.9%) in the direct laryngoscope group had a serious complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9).
Safety outcomes , including esophageal intubation, tooth injury, and aspiration, were similar in the two groups.
Conclusions Among critically ill adults undergoing tracheal intubation in an emergency department or ICU, use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than use of a direct laryngoscope. |
(Funded by the US Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195. opens in new tab.)
