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

Published online by Cambridge University Press:  14 December 2022

Ali Pourmand Open the ORCID record for Ali Pourmand [Opens in a new window] ,
Emily Terrebonne ,
Stephen Gerber ,
Jeffrey Shipley  and
Quincy K. Tran
Ali Pourmand*
Affiliation:
Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC USA
Emily Terrebonne
Affiliation:
Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC USA
Stephen Gerber
Affiliation:
Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC USA
Jeffrey Shipley
Affiliation:
Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC USA
Quincy K. Tran
Affiliation:
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, Maryland USA
*
Correspondence: Ali Pourmand, MD, MPH, RDMS Department of Emergency Medicine George Washington University School of Medicine and Health Sciences 2120 L St. Washington, DC 20037 USA E-mail: Pourmand@gwu.edu
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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 I2 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; P = .041; I2 = 87%). The I2 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; P = .021; I2 = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; P = .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.

Keywords

direct laryngoscopyendotracheal tubeintubationprehospitalvideo laryngoscopy
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 1 , February 2023 , pp. 111 - 121
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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