Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

Matthew E. Prekker, Brian E. Driver, Stacy A. Trent, Daniel Resnick-Ault, Kevin P. Seitz, Derek W. Russell, John P. Gaillard, Andrew J. Latimer, Shekhar A. Ghamande, Kevin W. Gibbs, Derek J. Vonderhaar, Micah R. Whitson, Christopher R. Barnes, Jeremy P. Walco, Ivor S. Douglas, Vijay Krishnamoorthy, Alon Dagan, Jill J. Bastman, Bradley D. Lloyd, Sheetal GandotraJordan K. Goranson, Steven H. Mitchell, Heath D. White, Jessica A. Palakshappa, Alyssa Espinera, David B. Page, Aaron Joffe, Sydney J. Hansen, Christopher G. Hughes, Tobias George, J. Taylor Herbert, Nathan I. Shapiro, Steven G. Schauer, Brit J. Long, Brant Imhoff, Li Wang, Jillian P. Rhoads, Kelsey N. Womack, David R. Janz, Wesley H. Self, Todd W. Rice, Adit A. Ginde, Jonathan D. Casey, Matthew W. Semler

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Background Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain. Methods In a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death. Results The trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups. Conclusions Among critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.)

Original languageEnglish (US)
Pages (from-to)418-429
Number of pages12
JournalNew England Journal of Medicine
Volume389
Issue number5
DOIs
StatePublished - 2023
Externally publishedYes

Keywords

  • Clinical Medicine
  • Critical Care
  • Emergency Medicine
  • Emergency Medicine General
  • Hospital-Based Clinical Medicine
  • Mechanical Ventilation
  • Pulmonary/Critical Care
  • Pulmonary/Critical Care General

ASJC Scopus subject areas

  • General Medicine

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