Are we there yet? The long journey of videolaryngoscopy into the mainstream

More on deaths from unrecognised oesophageal intubation

“…It is, therefore, notable that both versions of the Cochrane review of videolaryngoscopy vs. direct laryngoscopy [3,7] report numerous benefits of videolaryngoscopy with large, statistically significant treatment effects, including improved laryngeal view; reduced failure; fewer attempts; less hypoxaemia; and less trauma. These results not only indicate unequivocally that videolaryngoscopy is more effective than direct laryngoscopy [3,7,8] but also equate to evidence of improved safety. When also considering the legion of human factor benefits to the airway team of videolaryngoscopy with a shared view [9], we conclude quite simply that videolaryngoscopy is better for our patients.…”

Videolaryngoscopy in anesthesia and perioperative medicine: innovations, challenges, and best practices

“…In a recent editorial from Hansel and El-Boghdadly, a trial sequential analysis was performed, estimating a sample size of 1502 participants to answer the questions about first-attempt success and failed intubation. 5 This trial sequential analysis indicates that the necessary sample size to address these inquiries had already been attained by 2015. Consequently, future investigations and meta-analyses comparing the risk and benefit profiles of video laryngoscopy and direct laryngoscopy in adult populations are unlikely to yield altered outcomes.…”

“…Despite debates on the superiority of the video laryngoscope in relation to direct laryngoscopy, enough evidence can prove it, even though there is a low standardization of clinical outcomes. 5 The video laryngoscope is also better to train residents and fellows since it is possible to share the image of the laryngoscopy with more than one operator. However, opinions on whether video laryngoscopes should become the primary device for all tracheal intubations, regardless of anticipated difficulty, remain divided.…”

“…Although the use of video laryngoscopes has proven to be a safe approach for the management of difficult airways in experienced hands, information is sparse for novices. 5 This is true not only in theatre, where anesthesiologist residents conduct airway management, but also in emergency and intensive care departments, where undergraduate students and residents play a particular role in managing emergency airways.…”

Macintosh-style videolaryngoscope use for tracheal intubation in elective surgical patients revisited: a sub-analysis of the 2022 Cochrane review data

“…A systematic review of 21 meta-analyses comparing videolaryngoscopy (VL) with direct laryngoscopy (DL) found the majority of meta-analyses examined had grouped together Macintosh-style and hyper-angulated videolaryngoscope blades, which the authors concluded could potentially mislead airway managers in their choice of which videolaryngoscope to employ for a particular patient or scenario [ 3 ]. In their editorial on the subject of VL versus DL, Hansel and El-Boghdadly stated that the threshold of evidence required to support the superiority of VL over DL in achieving first-pass success (FPS) had been reached in 2015 [ 4 ], before the first Cochrane review on the topic had been published [ 5 ] ― though Hansel and El-Boghdadly did not recommend any particular VL device. Carvalho et al ’s subsequent network meta-analysis did attempt to rank videolaryngoscopes; however, they were unable to report any single videolaryngoscope that performed significantly better than others for preventing failed intubation [ 6 ].…”