Efficacy of Video Laryngoscopy vs. Direct Laryngoscopy During Urgent Endotracheal Intubation: A Randomized Controlled Trial

Abstract

PURPOSE: To assess the efficacy of video laryngoscopy use during urgent endotracheal intubation (UEI) in critically-ill patients. METHODS: We performed a single-center prospective randomized controlled trial that compared UEI using a direct laryngoscope (DL) versus a video-laryngoscope (VL) by Pulmonary/Critical Care Medicine (PCCM) fellows from September 2012 to March 2013. In the first month of fellowship, all PCCM fellows participated in a multi-component, validated training program on airway management including instruction in DL and VL techniques. Inclusion criteria were all patients undergoing UEI by a PCCM fellow. Exclusion criteria were elective intubations, oxygen saturation below 92% after bag mask ventilation, and presence of recognized difficult airway. Each fellow utilized a sequential even/odd randomization strategy. The primary outcome measure was the rate of first pass success (FPS). Secondary outcomes were the rates of complications including severe desaturation (sat <80%), hypotension (SBP <70), and cardiac arrest. RESULTS: 114 consecutive UEI performed by PCCM fellows were included. 56 were randomized to the VL group and 58 to the DL group. Apache scores were similar between groups (19.2 +/- 8.8 vs. 19.7 +/- 9.7). 71% of the VL group achieved FPS compared to 40% of the DL group (p< 0.001). 9 % of UEI in the VL group required more than 2 attempts compared to 47% in the DL group (p< 0.001). All unsuccessful DL patients were successfully intubated with VL, 81% on the first attempt. The number of esophageal intubations (0 vs. 4, p