Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2020

01-12-2020 | Rapid Sequence Induction | Review

Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients–a systematic review and meta-analysis

Authors: Jia Jiang, Na Kang, Bo Li, An-Shi Wu, Fu-Shan Xue

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2020

Login to get access

Abstract

Objective

This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients.

Methods

The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study.

Results

Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators’ expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03).

Conclusions

Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.
Appendix
Available only for authorised users
Literature
1.
Cook TM, Woodall N, Harper J. Benger J; fourth National Audit Project. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106(5):632–42.CrossRefPubMed
2.
Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34(9):2355–61.PubMedCrossRef
3.
Sakles JC, Javedani PP, Chase E, Garst-Orozco J, Guillen-Rodriguez JM, Stolz U. The use of a video laryngoscope by emergency medicine residents is associated with a reduction in esophageal intubations in the emergency department. Acad Emerg Med. 2015;22(6):700–7.PubMedCrossRef
4.
De Jong A, Clavieras N, Conseil M, Coisel Y, Moury PH, Pouzeratte Y, et al. Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study. Intensive Care Med. 2013;39(12):2144–52.PubMedCrossRef
5.
Hypes CD, Stolz U, Sakles JC, Joshi RR, Natt B, Malo J, et al. Video laryngoscopy improves odds of first-attempt success at intubation in the intensive care unit. A propensity-matched analysis. Ann Am Thorac Soc. 2016;13(3):382–90.PubMedCrossRef
6.
Kory P, Guevarra K, Mathew JP, Hegde A, Mayo PH. The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill. Anesth Analg. 2013;117(1):144–9.PubMedCrossRef
7.
Lakticova V, Koenig SJ, Narasimhan M, Mayo PH. Video laryngoscopy is associated with increased first pass success and decreased rate of esophageal intubations during urgent endotracheal intubation in a medical intensive care unit when compared to direct laryngoscopy. J Intensive Care Med. 2015;30(1):44–8.PubMedCrossRef
8.
Lee DH, Han M, An JY, Jung JY, Koh Y, Lim CM, et al. Video laryngoscopy versus direct laryngoscopy for tracheal intubation during in-hospital cardiopulmonary resuscitation. Resuscitation. 2015;89:195–9.PubMedCrossRef
9.
Noppens RR, Geimer S, Eisel N, David M, Piepho T. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: a prospective, comparative study in the ICU. Crit Care. 2012;16(3):R103.PubMedPubMedCentralCrossRef
10.
Okamoto H, Goto T, Wong ZSY, Hagiwara Y, Watase H, Hasegawa K; Japanese Emergency Medicine Network investigators. Comparison of video laryngoscopy versus direct laryngoscopy for intubation in emergency department patients with cardiac arrest: a multicentre study. Resuscitation 2019; 136:70–77.PubMedCrossRef
11.
Park SO, Kim JW, Na JH, Lee KH, Lee KR, Hong DY, Baek KJ. Video laryngoscopy improves the first-attempt success in endotracheal intubation during cardiopulmonary resuscitation among novice physicians. Resuscitation. 2015;89:188–94.PubMedCrossRef
12.
Vassiliadis J, Tzannes A, Hitos K, Brimble J, Fogg T. Comparison of the C-MAC video laryngoscope with direct Macintosh laryngoscopy in the emergency department. Emerg Med Australas. 2015;27(2):119–25.PubMedCrossRef
13.
Driver B, Prekker M, Moore J, Schick AL, Reardon RF, Miner JR. Direct versus video laryngoscopy using the C-MAC for tracheal intubation in the emergency department, a randomized controlled trial. Acad Emerg Med. 2016;23(4):433–9.PubMedCrossRef
14.
Gao YX, Song YB, Gu ZJ, Zhang JS, Chen XF, Sun H, Lu Z. Video versus direct laryngoscopy on successful first pass endotracheal intubation in ICU patients. World J Emerg Med. 2018;9(2):99–104.PubMedPubMedCentralCrossRef
15.
Goksu E, Kilic T, Yildiz G, Unal A, Kartal M. Comparison of the C-MAC video laryngoscope to the Macintosh laryngoscope for intubation of blunt trauma patients in the ED. Turk J Emerg Med. 2016;16(2):53–6.PubMedPubMedCentralCrossRef
16.
Griesdale D, Chau A, Isac G, Ayas N, Foster D, Irwin C. Choi P; Canadian critical care trials group. Video-laryngoscopy versus direct laryngoscopy in critically ill patients: a pilot randomized trial. Can J Anesth. 2012;59(11):1032–9.PubMedCrossRef
17.
Janz DR, Semler MW, Lentz RJ, Matthews DT, Assad TR, Norman BC. Et al; facilitating EndotracheaL intubation by laryngoscopy technique and apneic oxygenation within the ICU investigators and the pragmatic critical care research group. Randomized trial of video laryngoscopy for endotracheal intubation of critically ill adults. Crit Care Med. 2016;44(11):1980–7.PubMedPubMedCentralCrossRef
18.
Kim J, Park S, Lee K, Hong DY, Baek KJ, Lee YH, et al. Video laryngoscopy vs. direct laryngoscopy: which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators. Resuscitation 2016; 105: 196–202.PubMedCrossRef
19.
Lascarrou J, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T, Mercier E. Et al; clinical research in intensive care and Sepsis (CRICS) group. Video laryngoscopy vs direct laryngoscopy on successful first-pass Orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317(5):483–93.PubMedCrossRef
20.
Silverberg MJ, Li N, Acquah SO, Kory PD. Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial. Crit Care Med. 2015;43(3):636–41.PubMedCrossRef
21.
Sulser S, Ubmann D, Schlaepfer M, Brueesch M, Goliasch G, Seifert B, et al. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: a randomised clinical trial. Eur J Anaesthesiol. 2016;33(12):943–8.PubMedCrossRef
22.
Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, et al. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. J Trauma Acute Care Surg. 2013;75(2):212–9.PubMedCrossRef
23.
Jiang J, Ma D, Li B, Yue Y, Xue F. Video laryngoscopy does not improve the intubation outcomes in emergency and critical patients-a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2017;21(1):288.PubMedPubMedCentralCrossRef
24.
Arulkumaran N, Lowe J, Ions R, Mendoza M, Bennett V, Dunser MW. Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: a systematic review and meta-analysis. Br J Anaesth. 2018;120(4):712–24.PubMedCrossRef
25.
Savino PB, Reichelderfer S, Mercer MP, Wang RC, Sporer KA. Direct versus video laryngoscopy for Prehospital intubation: a systematic review and Meta-analysis. Acad Emerg Med. 2017;24(8):1018–26.PubMedCrossRef
26.
Bhattacharjee S, Maitra S, Baidya DK. A comparison between video laryngoscopy and direct laryngoscopy for endotracheal intubation in the emergency department: a meta-analysis of randomized controlled trials. J Clin Anesth. 2018;47:21–6.PubMedCrossRef
27.
Zhao BC, Huang TY, Liu KX. Video laryngoscopy for ICU intubation: a meta-analysis of randomised trials. Intensive Care Med. 2017;43(6):947–8.PubMedCrossRef
28.
Huang HB, Peng JM, Xu B, Liu GY, Du B. Video laryngoscopy for endotracheal intubation of critically ill adults: a systemic review and Meta-analysis. Chest. 2017;152(3):510–7.PubMedCrossRef
29.
De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40(5):629–39.PubMed
30.
Moher D, Liberati A, Tetzlaff J. Altman DG; PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.CrossRefPubMed
31.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015; 350: g7647.
32.
Cochrane: HJG. Cochrane handbook for systematic reviews of interventions version 5.1[updated March 2011] [last accessed on 15.6.2015]: The Cochrane collaboration. 2011. www.​cochrane-handbook.​org
33.
Sterne J, Higgins J, Reeves B, editors. A Cochrane risk of bias assessment tool: for non-randomized studies of interventions (ACROBAT-NRSI), vol. 24; 2014. Available from: Version1.0.0. http://​www.​riskofbias.​info. Accessed on 01/11/2017.
34.
35.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.PubMedCrossRef
36.
Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y. Schünemann HJ; GRADE working group. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336(7651):995–8.PubMedPubMedCentralCrossRef
37.
Brok J, Thorlund K, Wetterslev J, Gluud C. Apparently conclusive meta-analyses may be inconclusive--trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol. 2009;38(1):287–98.PubMedCrossRef
38.
TSA: Trial Sequential Analysis Viewer (TSA Viewer) [Computer program]. Version 0.9.5.10 Beta. Copenhagen: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, 2016.
39.
Khandelwal N, Galgon RE, Ali M, Joffe AM. Cardiac arrest is a predictor of difficult tracheal intubation independent of operator experience in hospitalized patients. BMC Anesthesiol. 2014;14:38.PubMedPubMedCentralCrossRef
40.
Driver BE, Klein LR, Schick AL, Prekker ME, Reardon RF, Miner JR. The occurrence of aspiration pneumonia after emergency endotracheal intubation. Am J Emerg Med. 2018;36(2):193–6.PubMedCrossRef
41.
Platts-Mills TF, Campagne D, Chinnock B, Snowden B, Glickman LT, Hendey GW. A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department. Acad Emerg Med. 2009;16(9):866–71.PubMedCrossRef
42.
Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth. 2013;60(2):184–91.PubMedCrossRef
43.
Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth. 2016;116(5):670–9.PubMedCrossRef
44.
van Zundert A, Pieters B, Doerges V, Gatt S. Videolaryngoscopy allows a better view of the pharynx and larynx than classic laryngoscopy. Br J Anaesth. 2012;109(6):1014–5.PubMedCrossRef
45.
Sorour K, Donovan L. Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report. J Clin Anesth. 2015;27(2):168–9.PubMedCrossRef
46.
DuCanto J, Serrano KD, Thompson RJ. Novel airway training tool that simulates vomiting: suction-assisted laryngoscopy assisted decontamination (SALAD) system. West J Emerg Med. 2017;18(1):117–20.PubMedCrossRef
47.
Mosier JM, Whitmore SP, Bloom JW, Snyder LS, Graham LA, Carr GE, Sakles JC. Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit. Crit Care. 2013;17:R237.PubMedPubMedCentralCrossRef
48.
Michailidou M, O'Keeffe T, Mosier JM, Friese RS, Joseph B, Rhee P, Sakles JC. A comparison of video laryngoscopy to direct laryngoscopy for the emergency intubation of trauma patients. World J Surg. 2015;39(3):782–8.PubMedCrossRef
49.
Sakles JC, Mosier JM, Patanwala AE, Arcaris B, Dicken JM. The utility of the C-MAC as a direct laryngoscope for intubation in the emergency department. J Emerg Med 2016; 51(4): 349–357.PubMedCrossRef
50.
Sakles JC, Cosentino ML. Airway management in the emergency department: a comparison of CMAC video laryngoscopy to direct laryngoscopy. Acad Emerg Med. 2011;18:S35.
51.
Sakles JC, Javedani PP, Jessica GO, Garst-Orozco J, Guillen-Rodriguez JM, Stolz U. Video laryngoscopy reduces the rate of esophageal intubations performed by emergency medicine residents compared to direct laryngoscopy. Acad Emerg Med. 2013;20:S297.
52.
Sakles JC, Mosier J, Chiu S, Cosentino M, Kalin L. A comparison of the C-MAC video laryngoscope to the macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012;60(6):739–48.PubMedPubMedCentralCrossRef
53.
Sakles JC, Mosier JM, Chiu S, Keim SM. Tracheal intubation in the emergency department: a comparison of GlideScope® video laryngoscopy to direct laryngoscopy in 822 intubations. J Emerg Med. 2012;42(4):400–5.PubMedCrossRef
54.
Sakles JC, Mosier JM, Patanwala AE, Dicken JM, Kalin L, Javedani PP. The C-MAC® video laryngoscope is superior to the direct laryngoscope for the rescue of failed first-attempt intubations in the emergency department. J Emerg Med. 2015;48(3):280–6.PubMedCrossRef
55.
Shirakura Y, Okamoto H, Watase H, Hasegawa K. Video laryngoscopy does not improve the first pass success rate during cardiopulmonary resuscitation in the emergency department: An analysis of multicenter observational study. Ann Emerg Med. 2015;66(4):S37.CrossRef
56.
Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane systematic review. Br J Anaesth. 2017;119(3):369–83.PubMedCrossRef
57.
Mulcaster JT, Mills J, Hung OR, MacQuarrie K, Law JA, Pytka S, et al. Laryngoscopic intubation: learning and performance. Anesthesiology. 2003;98(1):23–7.PubMedCrossRef
58.
de Oliveira Filho GR. The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method. Anesth Analg. 2002;95(2):411–6.PubMed
Metadata
Title
Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients–a systematic review and meta-analysis
Authors
Jia Jiang
Na Kang
Bo Li
An-Shi Wu
Fu-Shan Xue
Publication date
01-12-2020
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-020-0702-7

Other articles of this Issue 1/2020

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2020 Go to the issue

Original research

Establishment of an extracorporeal cardio-pulmonary resuscitation program in Berlin – outcomes of 254 patients with refractory circulatory arrest

Original research

The predictive value of variables measurable in the ambulance and the development of the Predict Sepsis screening tools: a prospective cohort study

Original research

Mechanical chest compression devices in the helicopter emergency medical service in Switzerland

Original research

Impact of blunt chest trauma on outcome after traumatic brain injury– a matched-pair analysis of the TraumaRegister DGU®

Original research

High HbA1c is associated with decreased 6-month survival and poor outcomes after out-of-hospital cardiac arrest: a retrospective cohort study

Editorial

Burn care: before the burn center