• Journal: British Journal of Anaesthesia

• PMID: 35820934

• Type of study: Systematic review and meta-analysis

• Objective

  • To evaluate the risks of tracheal intubation associated with videolaryngoscopy compared to direct laryngoscopy

• Methods

  • 222 studies included

    • 64 studies from prior meta-analysis

    • 158 new studies

  • Study eligibility

    • RCTs comparing VL and DL

    • Adults (>16 years of age)

    • OR, ICU, ED and pre-hospital

  • Exclusion criteria

    • Awake intubation

    • Optical stylets and flexible fiberoptic intubating devices

    • Simulated intubations (i.e. manikins)

  • Types of VL

    • Macintosh-style

    • Hyperangulated

    • Channeled-blade

• Results

  • All three types of VL were individually associated with decreased rates of failed intubation and increased first-attempt success

  • When the three types of VL were treated as one single group, VL resulted in

    • Fewer failed intubations

    • Fewer hypoxemic events

    • Increased first attempt success

    • Reduced # of esophageal intubations

• Strengths

  • Large number of subjects

  • Examined a variety of types of VL

  • Clinically relevant question

• Weaknesses

  • Generalizability to non-adults and out-of-OR environments

  • VL types not compared to each other

  • Not enough data on experience of intubators

  • No blinding of types of laryngoscopes to intubators

  • Publication bias

• Key Point: Use of videolaryngoscopy, as compared to direct laryngoscopy, results in a number of positive outcomes including reduced rates of failed intubations and improved first-attempt success

Br J Anaesth. 2022 Oct;129(4):612-623