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Meta-Analysis
. 2024 Mar 12;13(1):85.
doi: 10.1186/s13643-024-02500-9.

Video laryngoscopy versus direct laryngoscopy in achieving successful emergency endotracheal intubations: a systematic review and meta-analysis of randomized controlled trials

Mohammed Alsabri  1 , Omar Ahmed Abdelwahab  2 , Ahmed Bostamy Elsnhory  3 , Rehab Adel Diab  3 , Vaishnavi Sabesan  4 , Muhammad Ayyan  5 , Christopher McClean  6 , Ayman Alhadheri  7
Affiliations
Meta-Analysis

Video laryngoscopy versus direct laryngoscopy in achieving successful emergency endotracheal intubations: a systematic review and meta-analysis of randomized controlled trials

Mohammed Alsabri et al. Syst Rev. .

Abstract

Background: Intubating a patient in an emergent setting presents significant challenges compared to planned intubation in an operating room. This study aims to compare video laryngoscopy versus direct laryngoscopy in achieving successful endotracheal intubation on the first attempt in emergency intubations, irrespective of the clinical setting.

Methods: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception until 27 February 2023. We included only randomized controlled trials that included patients who had undergone emergent endotracheal intubation for any indication, regardless of the clinical setting. We used the Cochrane risk-of-bias assessment tool 2 (ROB2) to assess the included studies. We used the mean difference (MD) and risk ratio (RR), with the corresponding 95% confidence interval (CI), to pool the continuous and dichotomous variables, respectively.

Results: Fourteen studies were included with a total of 2470 patients. The overall analysis favored video laryngoscopy over direct laryngoscopy in first-attempt success rate (RR = 1.09, 95% CI [1.02, 1.18], P = 0.02), first-attempt intubation time (MD = - 6.92, 95% CI [- 12.86, - 0.99], P = 0.02), intubation difficulty score (MD = - 0.62, 95% CI [- 0.86, - 0.37], P < 0.001), peri-intubation percentage of glottis opening (MD = 24.91, 95% CI [11.18, 38.64], P < 0.001), upper airway injuries (RR = 0.15, 95% CI [0.04, 0.56], P = 0.005), and esophageal intubation (RR = 0.37, 95% CI [0.15, 0.94], P = 0.04). However, no difference between the two groups was found regarding the overall intubation success rate (P > 0.05).

Conclusion: In emergency intubations, video laryngoscopy is preferred to direct laryngoscopy in achieving successful intubation on the first attempt and was associated with a lower incidence of complications.

Keywords: Direct laryngoscope; Emergent airway; Emergent intubation; Endotracheal intubation; First-attempt success; Video laryngoscopy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies’ screening and selection
Fig. 2
Fig. 2
Risk-of-bias assessment of the included studies
Fig. 3
Fig. 3
Forest plot comparing video laryngoscope and direct laryngoscope groups regarding the first-attempt success rate
Fig. 4
Fig. 4
Forest plot comparing video laryngoscope and direct laryngoscope groups regarding A the overall intubation success rate and B the overall intubation time
Fig. 5
Fig. 5
Forest plot comparing video laryngoscope and direct laryngoscope groups regarding the adverse events and complications. A The incidence of desaturation. B Upper airway injuries. C Esophageal intubation. D Aspiration. E Cardiac arrest. F The incidence of pO2 < 90
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