Videolaryngoscopy vs. Direct Laryngoscopy for Elective Airway Management in Paediatric Anaesthesia: A prospective randomised controlled trial

Abstract

BACKGROUNDThe indirect visualisation of the glottic area with a videolaryngoscope could improve intubation conditions which may possibly lead to a higher success rate of the first intubation attempt.OBJECTIVEComparison of videolaryngoscopy and direct laryngoscopy for elective airway management in paediatric patients.DESIGNProspective randomised controlled trial.SETTINGSOperating room.PARTICIPANTS535 paediatric patients undergoing elective anaesthesia with tracheal intubation. 501 patients were included in the final analysis.INTERVENTIONSPatients were randomly allocated to the videolaryngoscopy group (n=265) and to the direct laryngoscopy group (n=269) for the primary airway management.MAIN OUTCOME MEASURESThe first attempt intubation success rate was assessed as the primary outcome. The secondary outcomes were defined as: The time to successful intubation (time to the first EtCO2wave), the overall intubation success rate, the number of intubation attempts, the incidence of complications, and the impact of the length of the operator's clinical practice.RESULTSThe study was terminated after the planned interim analysis for futility. There were no significant demographic differences between the two groups. The first attempt intubation success rate was lower in the videolaryngoscopy group; 86.8% (n=211) vs. 92.6% (n=239), P=0.046. The mean time to the first EtCO2wave was longer in the videolaryngoscopy group at 39.0s±36.7 compared to the direct laryngoscopy group, 23.6s±24.7 (P<0.001). There was no difference in the overall intubation success rate, in the incidence of complications nor significant difference based on the length of the clinical practice of the operator.CONCLUSIONSThe first attempt intubation success rate was lower in the videolaryngoscopy group in comparison to the direct laryngoscopy group. The time needed for successful intubation with videolaryngoscopy was longer compared with direct laryngoscopy.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT03747250.