October 30, 2023

Video laryngoscopy leads to higher success rates than direct laryngoscopy

Editor's Note

Video laryngoscopy was found to lead to higher intubation success rates over direct laryngoscopy in critically ill adult patients, an August 2023 randomized controlled trial published by the The New England Journal of Medicine shows. The findings were consistent whether they were intubated in an emergency room or intensive care unit (ICU).

The large, multicenter, randomized trial was conducted at 17 emergency departments and ICUs, with critically ill adults undergoing tracheal intubation randomly assigned to the video-laryngoscope group or the direct-laryngoscope group. Of the total 1,417 patients enrolled, 705 received video laryngoscopy and first-attempt success was 85%, while 712 had direct laryngoscopy with 71% first-attempt success.

Secondary outcomes were similar between groups and included the occurrence of severe complications during intubation, defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death. The study confirmed that 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.


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