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Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial

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Originally published in JAMA Network 18 Mach 2024

This cluster-randomized crossover trial based in a  US academic hospital assessed whether initial laryngoscopy with video laryngoscopy or direct laryngoscopy reduces intubation attempts per surgical procedure. 

Adult patients undergoing elective or emergent cardiac, thoracic, or vascular surgeries requiring single-lumen endotracheal intubation were included. Two sets of 11 operating rooms were randomized weekly to perform either hyper-angled video laryngoscopy or direct laryngoscopy for initial intubation.

Among 8429 surgical procedures in 7736 patients, video laryngoscopy decreased the need for multiple intubation attempts compared to direct laryngoscopy (1.7% vs 7.6%).
Intubation failure rates were also lower with video laryngoscopy (0.27% vs 4.0%).  No significant differences were found in airway and dental injuries between the two methods.

The study suggests that video laryngoscopy may facilitate smoother endotracheal intubation in surgical patients, indicating its potential as a preferred approach in such procedures.
 

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