Intubation in the Intensive Care Unit: C-MAC video laryngoscope versus Macintosh laryngoscope

Dey, Subhasish; Pradhan, Debasis; Saikia, Priyam; Bhattacharyya, Prithwis; Khandelwal, Hariom; Adarsha, K.N.

doi:10.1016/j.medin.2019.10.004

Cited by 19 publications

(4 citation statements)

References 20 publications

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“…Our results were consistent across multiple simulations and remained stable after random exclusion of studies. We identified one study as the main outlier [ 25 ]. A comprehensive explanation of statistical protocols used to explore heterogeneity is available in Additional 1 : Supplemental Results 1 and Additional 1 : Supplemental Figs.…”

Section: Resultsmentioning

confidence: 99%

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%

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

View full text Add to dashboard Cite

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“…This implies a significant gap between DL providers' sufficient ETI experience and VL providers' insufficient experience. Most of the included studies revealed that ETI experience for VL providers was limited to manikin training rather than actual patients (Supplementary Table S2) (34,42,44). This disparity in ETI experience may cause the DL-associated ETI success rate to be higher than the VL-associated success rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of video laryngoscopy with direct laryngoscopy for intubation success in critically ill patients: a systematic review and Bayesian network meta-analysis

et al. 2023

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IntroductionThis review compares the efficacy of video laryngoscopy (VL) with direct laryngoscopy (DL) for successful tracheal intubation in critically ill or emergency-care patients.MethodsWe searched the MEDLINE, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) that compared one or more video laryngoscopes to DL. Sensitivity analysis, subgroup analysis, and network meta-analysis were used to investigate factors potentially influencing the efficacy of VL. The primary outcome was the success rate of first-attempt intubation.ResultsThis meta-analysis included 4244 patients from 22 RCTs. After sensitivity analysis, the pooled analysis revealed no significant difference in the success rate between VL and DL (VL vs. DL, 77.3% vs. 75.3%, respectively; OR, 1.36; 95% CI, 0.84–2.20; I2 = 80%; low-quality evidence). However, based on a moderate certainty of evidence, VL outperformed DL in the subgroup analyses of intubation associated with difficult airways, inexperienced practitioners, or in-hospital settings. In the network meta-analysis comparing VL blade types, nonchanneled angular VL provided the best outcomes. The nonchanneled Macintosh video laryngoscope ranked second, and DL ranked third. Channeled VL was associated with the worst treatment outcomes.DiscussionThis pooled analysis found, with a low certainty of evidence, that VL does not improve intubation success relative to DL. Channeled VL had low efficacy in terms of intubation success compared with nonchanneled VL and DL.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285702, identifier: CRD42021285702.

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“…Previous trials randomising patients to the use of a video laryngoscope or a direct laryngoscope during emergency tracheal intubation in prehospital, [13][14][15][16][17][18] ED [19][20][21][22][23][24][25] and ICU settings [26][27][28][29][30][31][32] have been small and heterogeneous and have generally suggested that while a video laryngoscope improves the view of the larynx and reduces the incidence of oesophageal intubation, it may not affect the incidence of successful intubation on the first attempt. Findings were similar in the largest such trial to date, a 371-patient, multicentre, randomised clinical trial in French medical ICUs in which the use of video laryngoscope failed to improve successful intubation on the first attempt (68% vs 70%; p=0.60) and was associated with a greater incidence of severe periprocedural complications in post-hoc analyses.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

DirEct versus VIdeo LaryngosCopE (DEVICE): protocol and statistical analysis plan for a randomised clinical trial in critically ill adults undergoing emergency tracheal intubation

et al. 2023

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IntroductionAmong critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the first attempt is associated with an increased risk of complications. Two types of laryngoscopes are commonly available: direct laryngoscopes and video laryngoscopes. For critically ill adults undergoing emergency tracheal intubation, it remains uncertain whether the use of a video laryngoscope increases the incidence of successful intubation on the first attempt compared with the use of a direct laryngoscope.Methods and analysisTheDirEct versusVIdeo LaryngosCopE(DEVICE) trial is a prospective, multicentre, non-blinded, randomised trial being conducted in 7 EDs and 10 ICUs in the USA. The trial plans to enrol up to 2000 critically ill adults undergoing orotracheal intubation with a laryngoscope. Eligible patients are randomised 1:1 to the use of a video laryngoscope or a direct laryngoscope for the first intubation attempt. The primary outcome is successful intubation on the first attempt. The secondary outcome is the incidence of severe complications between induction and 2 min after intubation, defined as the occurrence of one or more of the following: severe hypoxaemia (lowest oxygen saturation <80%); severe hypotension (systolic blood pressure <65 mm Hg or new or increased vasopressor administration); cardiac arrest or death. Enrolment began on 19 March 2022 and is expected to be completed in 2023.Ethics and disseminationThe trial protocol was approved with waiver of informed consent by the single institutional review board at Vanderbilt University Medical Center and the Human Research Protection Office of the Department of Defense. The results will be presented at scientific conferences and submitted for publication in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT05239195).

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Intubation in the Intensive Care Unit: C-MAC video laryngoscope versus Macintosh laryngoscope

Cited by 19 publications

References 20 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

Comparison of video laryngoscopy with direct laryngoscopy for intubation success in critically ill patients: a systematic review and Bayesian network meta-analysis

DirEct versus VIdeo LaryngosCopE (DEVICE): protocol and statistical analysis plan for a randomised clinical trial in critically ill adults undergoing emergency tracheal intubation

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