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Master of Public Health

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

AUTHORS

Prekker ME , Driver BE , Trent SA , Resnick-Ault D , Seitz KP , Russell DW , Gaillard JP , Latimer AJ , Ghamande SA , Gibbs KW , Vonderhaar DJ , Whitson MR , Barnes CR , Walco JP , Douglas IS , Krishnamoorthy V , Dagan A , Bastman JJ , Lloyd BD , Gandotra S , Goranson JK , Mitchell SH , White HD , Palakshappa JA , Espinera A , Page DB , Joffe A , Hansen SJ , Hughes CG , George T , Herbert JT , Shapiro NI , Schauer SG , Long BJ , Imhoff B , Wang L , Rhoads JP , Womack KN , Janz DR , Self WH , Rice TW , Ginde AA , Casey JD , Semler MW , , . The New England journal of medicine. 2023 6 16; ().

ABSTRACT

BACKGROUND: Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.

METHODS: In a multicenter, randomized trial conducted at 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 severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death.

RESULTS: The trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups.

CONCLUSIONS: Among critically ill adults undergoing tracheal intubation in an emergency department 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. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.).

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