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. 2017 Nov 24;21(1):288.
doi: 10.1186/s13054-017-1885-9.

Video Laryngoscopy Does Not Improve the Intubation Outcomes in Emergency and Critical Patients - A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Free PMC article

Video Laryngoscopy Does Not Improve the Intubation Outcomes in Emergency and Critical Patients - A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Jia Jiang et al. Crit Care. .
Free PMC article


Background: There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients.

Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017. Only randomized controlled trials comparing video and direct laryngoscopy for tracheal intubation in emergency department, intensive care unit, and prehospital settings were selected. The primary outcome was the first-attempt success rate. Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of evidence for all outcomes.

Results: Twelve studies (2583 patients) were included in the review for data extraction. Pooled analysis did not show an improved first-attempt success rate using video laryngoscopy (relative risk [RR], 0.93; P = 0.28; low-quality evidence). There was significant heterogeneity among studies (I 2 = 91%). Subgroup analyses showed that, in the prehospital setting, video laryngoscopy decreased the first-attempt success rate (RR, 0.57; P < 0.01; high-quality evidence) and overall success rate (RR, 0.58; 95% CI, 0.48-0.69; moderate-quality evidence) by experienced operators, whereas in the in-hospital setting, no significant difference between two devices was identified for the first-attempt success rate (RR, 1.06; P = 0.14; moderate-quality evidence), regardless of the experience of the operators or the types of video laryngoscopes used (P > 0.05), although a slightly higher overall success rate was shown (RR, 1.11; P = 0.03; moderate-quality evidence). There were no differences between devices for other outcomes (P > 0.05), except for a lower rate of esophageal intubation (P = 0.01) and a higher rate of Cormack and Lehane grade 1 (P < 0.01) when using video laryngoscopy.

Conclusions: On the basis of the results of this study, we conclude that, compared with direct laryngoscopy, video laryngoscopy does not improve intubation outcomes in emergency and critical patients. Prehospital intubation is even worsened by use of video laryngoscopy when performed by experienced operators.

Keywords: Airway management; Laryngoscope; Randomized controlled trial; Tracheal intubation.

Conflict of interest statement

Consent for publication

Not applicable.

Competing interests

All authors declare (1) receiving no support from any organization for the submitted work, (2) having no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years, and (3) having no other relationships or activities that could appear to have influenced the submitted work.

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Fig. 1
Fig. 1
Search process for identified records. RCT Randomized controlled trial
Fig. 2
Fig. 2
Risk of bias summary: judgments about each risk of bias item for each included study based on quality evaluation of 12 included studies. + Low risk, − High risk, ? Unknown
Fig. 3
Fig. 3
VL vs. DL for first-attempt success rate based on different settings (a), experience levels of operators in in-hospital settings (b), and different types of video laryngoscopy in in-hospital settings (c). VL Video laryngoscopy, DL Direct laryngoscopy, M-H Mantel-Haenszel

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