Direct laryngoscope versus McGRATH video-laryngoscope for tracheal intubation in trauma emergency: A randomised control trial

Ajith, P; Bandyopadhyay, Anjishnujit; Meena, Shyam Charan; Jain, Kajal; Aggarwal, Sameer; Gupta, Sunil

doi:10.1016/j.ajem.2021.09.042

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…After removing duplicates, 72 articles were retrieved and reviewed in full for possible inclusion. Of these, 14 RCTs met all inclusion criteria and were included in the primary analysis [ 11 , 12 , 14 , 15 , 24 – 32 ]. We included a total of 3981 patients, of whom 2002 (50.3%) patients were assigned to VL and 1979 (49.7%) were assigned to DL.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the primary outcome, thirteen studies carried high risk of bias due to unblinding of outcome adjudicators due to the nature of intervention, however the DEVICE trial was scored at a low risk of bias due to the presence of an independent observer keeping track of the number of intubation attempts [ 12 ]. Moreover, seven studies had some concerns of bias due to the inexistence of protocols [ 14 , 15 , 24 – 27 , 33 ]. Funnel plot and Egger’s test (p = 0.048) suggested publication bias in the primary outcome, as represented in Additional 1 : Supplemental Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Previous meta-analyses showed no significant difference in successful intubation on the first attempt in critically ill patients [ 7 , 13 ]. However, several randomized controlled trials (RCTs) have been published recently, including the Direct versus Video Laryngoscope (DEVICE) trial, the largest to date, showing promising results [ 12 , 14 , 15 ]. To shed light on this controversy, we performed an updated systematic review and meta-analysis of RCTs comparing VL versus DL in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

Araújo,

Rivera,

Martins

et al. 2024

Crit Care

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Background The utilization of video laryngoscopy (VL) has demonstrated superiority over direct laryngoscopy (DL) for intubation in surgical settings. However, its effectiveness in the intensive care unit and emergency department settings remains uncertain. Methods We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing VL versus DL in critically ill patients. Critical setting was defined as emergency department and intensive care unit. This systematic review and meta-analysis followed Cochrane and PRISMA recommendations. R version 4.3.1 was used for statistical analysis and heterogeneity was examined with I2 statistics. All outcomes were submitted to random-effect models. Results Our meta-analysis of 14 RCTs, compromising 3981 patients assigned to VL (n = 2002) or DL (n = 1979). Compared with DL, VL significantly increased successful intubations on the first attempt (RR 1.12; 95% CI 1.04–1.20; p < 0.01; I2 = 82%). Regarding adverse events, VL reduced the number of esophageal intubations (RR 0.44; 95% CI 0.24–0.80; p < 0.01; I2 = 0%) and incidence of aspiration episodes (RR 0.63; 95% CI 0.41–0.96; p = 0.03; I2 = 0%) compared to DL. Conclusion VL is a more effective and safer strategy compared with DL for increasing successful intubations on the first attempt and reducing esophageal intubations in critically ill patients. Our findings support the routine use of VL in critically ill patients. Registration CRD42023439685 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439685. Registered 6 July 2023.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

Araújo,

Rivera,

Martins

et al. 2024

Crit Care

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“…We read the article Ajith et al [ 1 ] with great interest. Airway management is a key skill in an emergency medical service setting.…”

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confidence: 99%

Blind intubation in COVID-19 patients airway management

Wieczorek

2022

The American Journal of Emergency Medicine

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Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials

McDougall,

Flindall,

Forestell

et al. 2024

Critical Care Medicine

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Objectives: Given the uncertainty regarding the optimal approach to laryngoscopy for the intubation of critically ill adult patients, we conducted a systematic review and meta-analysis to compare video laryngoscopy (VL) vs. direct laryngoscopy (DL) for intubation in emergency department and ICU patients. Data Sources: We searched MEDLINE, PubMed, Embase, Cochrane Library, and unpublished sources, from inception to February 27, 2024. Study Selection: We included randomized controlled trials (RCTs) of critically ill adult patients randomized to VL compared with DL for endotracheal intubation. Data Extraction: Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023469945). Data Synthesis: We included 20 RCTs (n = 4569 patients). Compared with DL, VL probably increases first pass success (FPS) (relative risk [RR], 1.13; 95% CI, 1.06–1.21; moderate certainty) and probably decreases esophageal intubations (RR, 0.47; 95% CI, 0.27–0.82; moderate certainty). VL may result in fewer aspiration events (RR, 0.74; 95% CI, 0.51–1.09; low certainty) and dental injuries (RR, 0.46; 95% CI, 0.19–1.11; low certainty) and may have no effect on mortality (RR, 0.97; 95% CI, 0.88–1.07; low certainty) compared with DL. Conclusions: In critically ill adult patients undergoing intubation, the use of VL, compared with DL, probably leads to higher rates of FPS and probably decreases esophageal intubations. VL may result in fewer dental injuries as well as aspiration events compared with DL with no effect on mortality.

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Direct laryngoscope versus McGRATH video-laryngoscope for tracheal intubation in trauma emergency: A randomised control trial

Cited by 4 publications

References 6 publications

Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials

Blind intubation in COVID-19 patients airway management

Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials

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