Comparison of Video Laryngoscopy Versus Direct Laryngoscopy for Orotracheal Intubation among Adults in Emergency Department

Abstract

Introduction: Video laryngoscopy for intubation has increased in frequency and there is mounting evidence suggesting increased first pass success, improved glottic view and fewer adverse events with its use. This study compared Video laryngoscopy and direct laryngoscopy with respect to first pass intubation success and adverse events in an emergency department setting.

Methods: A prospective, comparative study was done at Emergency department of Patan Academy of Health Sciences with sample size of 63 in each group, with total of 126 patients. Multivariable logistic regression was performed to assess the independent association between laryngoscopy technique and first-pass success after adjustment for age, sex, anticipated difficult airway, and Cormack–lehane grade.

Results: First-pass success was achieved in 44 (69.84%) patients in the Video laryngoscopy group and 38 (60.32%) in the direct laryngoscopy group (p=0.350). Adverse events occurred in 50 (79.37%) patients in the Video laryngoscopy group and 48 (76.19%) in the direct laryngoscopy group. Hypoxemia was present in both groups. After adjustment for patient and airway characteristics, Video laryngoscopy was not independently associated with first-pass success (adjusted OR 1.38, 95% CI 0.63–3.01; p=0.422), whereas CL Grade III–IV was associated with lower odds of first-pass success (adjusted OR 0.34, 95% CI 0.14–0.82; p=0.016).

Conclusions: Video laryngoscopy showed a numerically higher first-pass success rate than direct laryngoscopy, but this difference was not significant after adjustment for patient and airway characteristics. Difficult laryngoscopic view was independently associated with lower first-pass success, supporting the use of both techniques according to individual patient and airway characteristics.