Video laryngoscopy and direct laryngoscopy for cardiac arrest: A meta-analysis of clinical studies and trials

Yu-Ta Chien; Jiann-Ruey Ong; Ka-Wai Tam; El-Wui Loh

doi:10.1016/j.ajem.2023.08.028

Video laryngoscopy and direct laryngoscopy for cardiac arrest: A meta-analysis of clinical studies and trials

Am J Emerg Med. 2023 Nov:73:116-124. doi: 10.1016/j.ajem.2023.08.028. Epub 2023 Aug 16.

Authors

Yu-Ta Chien¹, Jiann-Ruey Ong², Ka-Wai Tam³, El-Wui Loh⁴

Affiliations

¹ Department of Emergency Medicine, Mennonite Christian Hospital, Emergency Department, Hualien City, Taiwan.
² Department of Emergency Medicine, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan.
³ Division of General Surgery, Department of Surgery, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
⁴ Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Medical Imaging, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan. Electronic address: lohelwui@tmu.edu.tw.

PMID: 37647846
DOI: 10.1016/j.ajem.2023.08.028

Abstract

Background: Intubation is an essential procedure in cardiopulmonary resuscitation (CPR). We conducted a systematic review and meta-analysis of trials and studies comparing the performance of video laryngoscope (VL) and direct laryngoscope (DL) in endotracheal intubation (ETI) during CPR in cardiac arrest (OHCA) patients.

Methods: We searched the PUBMED, EMBASE, and Cochrane library databases. We analyzed the first-pass success rate, total intubation time, Cormack-Lehane grade (CL grade), esophageal intubation rate, and dental injury rate among the in-hospital cardiac arrest (IHCA) patients or out-of-hospital cardiac arrest (OHCA) patients. We demonstrated the pooled results of continuous outcomes by mean difference (MD) and dichotomous outcomes by odds ratio (OR), with a 95% confidence interval (CI) using a random-effects model.

Results: We obtained six observational studies and one randomized control trial. The pooled results showed a significant increase in first-pass success rate (OR: 1.86, 95% CI: 1.41, 2.47), Cormack-Lehane (CL) grade (OR: 2.01, 95% CI: 1.59,2.53), and a decrease of esophageal intubation rate (OR: 0.25, 95% CI: 0.08, 0.85) in the VL group compared with DL group. Also, a non-significant decrease in dental injury rate [OR: 0.23, 95% CI: 0.05, 1.08) was observed in the VL group compared with the DL group. There was no statistical difference between the VL and DL groups, although the VL group seemed to have a shorter total intubation time (MD: -15.43, 95% CI: -34.67, 3.81). Types of laryngoscopes were not associated with the rate of ROSC [OR 1.01 (0.95,1.07); P = 0.83]. No differences in survival outcomes were observed between the two approaches.

Conclusions: Compared to DL, VL was found to be associated with first-pass success and CL grade. We recommend prioritizing VL over DL when performing ETIs for patients with cardiac arrest.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Direct laryngoscope; Endotracheal intubation; Video laryngoscope.