Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis

Authors

Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA.
Emily Terrebonne, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA.
Stephen Gerber, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA.
Jeffrey Shipley, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA.
Quincy K. Tran, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MarylandUSA.

Document Type

Journal Article

Publication Date

12-14-2022

Journal

Prehospital and disaster medicine

DOI

10.1017/S1049023X22002254

Keywords

direct laryngoscopy; endotracheal tube; intubation; prehospital; video laryngoscopy

Abstract

INTRODUCTION: Placing an endotracheal tube is a life-saving measure. Direct laryngoscopy (DL) is traditionally the default method. Video laryngoscopy (VL) has been shown to improve efficiency, but there is insufficient evidence comparing VL versus DL in the prehospital settings. This study, comprising a systematic review and random-effects meta-analysis, assesses current literature for the efficacy of VL in prehospital settings. METHODS: PubMed and Scopus databases were searched from their beginnings through March 1, 2022 for eligible studies. Outcomes were the first successful intubation, overall success rate, and number of total DL versus VL attempts in real-life clinical situations. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I values were used to assess heterogeneity. RESULTS: The search yielded seven studies involving 23,953 patients, 6,674 (28%) of whom underwent intubation via VL. Compared to DL, VL was associated with a statistically higher risk ratio for first-pass success (Risk Ratio [RR] = 1.116; 95% CI, 1.005-1.239; = .041; I = 87%). The I value for the subgroup of prospective studies was 0% compared to 89% for retrospective studies. In addition, VL was associated with higher likelihood of overall success rate (RR = 1.097; 95% CI, 1.01-1.18; = .021; I = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; = .008). CONCLUSION: The meta-analysis suggested that VL was associated with higher likelihood of achieving first-pass success, greater overall success rate, and lower number of intubation attempts for adults in the prehospital settings. This study had high heterogeneity, likely presenced by the inclusion of retrospective observational studies. Further studies with more rigorous methodology are needed to confirm these results.

APA Citation

Pourmand, Ali; Terrebonne, Emily; Gerber, Stephen; Shipley, Jeffrey; and Tran, Quincy K., "Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis" (2022). GW Authored Works. Paper 2102.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2102

Department

Emergency Medicine