The following is a summary of “Video laryngoscopy and direct laryngoscopy for cardiac arrest: A meta-analysis of clinical studies and trials,” published in the November 2023 issue of Emergency Medicine by Chien, et al.

Intubation is a critical procedure in cardiopulmonary resuscitation (CPR), particularly during cardiac arrest. For a systematic review and meta-analysis, researchers sought to compare the performance of video laryngoscope (VL) and direct laryngoscope (DL) in endotracheal intubation (ETI) for patients experiencing cardiac arrest, both in-hospital (IHCA) and out-of-hospital (OHCA).

A comprehensive search was conducted in PUBMED, EMBASE, and the Cochrane Library databases. The analysis focused on outcomes such as first-pass success rate, total intubation time, Cormack–Lehane grade (CL grade), esophageal intubation rate, and dental injury rate. Pooled results were presented using mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes, with a 95% CI utilizing a random-effects model.

Seven studies, including one randomized control trial, were included. Pooled results indicated a significantly higher first-pass success rate (OR: 1.86, 95% CI: 1.41, 2.47) and improved Cormack–Lehane grade (OR: 2.01, 95% CI: 1.59, 2.53) with VL compared to DL. The VL group also demonstrated a lower esophageal intubation rate (OR: 0.25, 95% CI: 0.08, 0.85) and a non-significant decrease in dental injury rate (OR: 0.23, 95% CI: 0.05, 1.08). Although the VL group exhibited a potentially shorter total intubation time (MD: -15.43, 95% CI: −34.67, 3.81), this was not statistically significant. The type of laryngoscope did not influence the return of spontaneous circulation (ROSC) rate (OR: 1.01, 95% CI: 0.95, 1.07; P = 0.83), and no significant differences in survival outcomes were observed between VL and DL.

In comparison to DL, VL was associated with higher first-pass success rates and improved CL grades during ETI in cardiac arrest patients. The findings supported the prioritization of VL over DL in the context of endotracheal intubation for patients experiencing cardiac arrest.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004400