Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic

Abstract

BACKGROUND The potential benefit of “videolaryngoscopy use in facilitating” tracheal intubation has already been established. Its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and after the early phases of the pandemic, whether institutions had acquired new devices during the COVID-19 pandemic, and whether there had been teaching on the devices acquired. DESIGN We designed a survey with 27 questions made available via the Joint Information Scientific Committee JISC online survey platform in English, French, Spanish, Chinese, Japanese and Portuguese. This was distributed through 18 anaesthetic and airway management societies. SETTING The survey was open for 54 to 90 days in various countries. The first responses were logged on the databases on 28 October 2021, with all databases closed on 26 January 2022. Reminders to participate were sent at the discretion of the administering organisations. PARTICIPANTS All anaesthetists and airway managers who received the study were eligible to participate. MAIN OUTCOME MEASURES Videolaryngoscopy use before the COVID-19 pandemic and at the time of the survey. RESULTS We received 4392 responses from 96 countries: 944/4336 (21.7%) were from trainees. Of the 3394 consultants, 70.8% (2402/3394) indicated no change in videolaryngoscopy use, 19.9% (675/3394) increased use and 9.3% (315/3393) reduced use. Among trainees 65.5% (618/943) reported no change in videolaryngoscopy use, 27.7% (261/943) increased use and 6.8% (64/943) reduced use. Overall, videolaryngoscope use increased by 10 absolute percentage points following the pandemic. CONCLUSIONS Videolaryngoscopy use increased following the early phase of the COVID-19 pandemic but this was less than might have been expected.

Epidemiology of videolaryngoscopy use

“…It seems then that, despite a significant increased availability of devices, very few clinicians changed their baseline practice, and the paucity of formal training reported may explain this finding, at least in part. 1 We think that these results should be interpreted with caution. Firstly, most respondents (85%) were colleagues working daily as anaesthesiologists, whereas only 7.2% of critical care and 1.6% of emergency medicine doctors participated in this survey.…”

“…We read with interest the report from the VL-iCUE survey on trends in videolaryngoscopy use before and after the initial phase of the COVID-19 pandemic. 1 The authors should be congratulated for their efforts to present a picture drawn from 96 different countries. Indeed, different resources, healthcare systems and organisations, training and even local practices may be responsible for a wide variability in the practice of airway management.…”

“…2,3 The study by Wylie and colleagues reported the unexpectedly small impact of the COVID-19 pandemic on clinicians' attitudes towards videolaryngoscopy use, with only a 10% increase of routine videolaryngoscopy use compared with prepandemic. 1 On the other hand, almost half of respondents affirmed that their departments acquired new videolaryngoscopes after the pandemic. It seems then that, despite a significant increased availability of devices, very few clinicians changed their baseline practice, and the paucity of formal training reported may explain this finding, at least in part.…”

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

“…Whilst this sub-analysis presents the evidence for the efficacy of Macintosh-style VL, the potential benefits to an individual patient may still be limited by lack of device availability/accessibility (though this appears to be improving following the COVID-19 pandemic [ 15 ]) and (in)adequacy of staff training in the use of any such device [ 16 ]. Regular practice with an institution’s chosen videolaryngoscope is essential in order for the full range of benefits to be conferred to patients.…”