Interesting study. May be more applicable to the ED setting compared with the sterile, controlled environment of the operating theatre with semi-elective fasted patients.
In the largest prospective, randomized trial to date, use of video laryngoscopy improved glottic visualization but did not increase procedural success or decrease complications compared to direct laryngoscopy in medical ICU patients.
Source: Janz DR, Semler MW, Lentz RJ, et al. Randomized trial of video laryngoscopy for endotracheal intubation of critically ill adults. Crit Care Med 2016;44:1980-1987.
AKA - The FELLOW trial (Facilitating EndotracheaL intubation by Laryngoscopy technique and apneic Oxygenation Within the ICU).
Design: A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.
Setting: Medical ICU in a tertiary, academic medical center.
Patients: Critically ill patients 18 years old or older.
Interventions: Patients were randomized 1:1 to video or direct laryngoscopy for the rst attempt at endotracheal intubation.
Measurements and Main Results: Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the rst laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator’s previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on rst attempt 2.02; 95% CI, 0.82– 5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy.
Conclusions: In critically ill adults undergoing endotracheal intuba- tion, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.
Limitations: The small but significant population of patients excluded from randomization in the FELLOW trial due to urgency or clinician judgment unfortunately limits the generalization of these findings to other high-risk populations.
Perhaps we shouldn’t throw out our Mac laryngoscopes yet.
best wishes for the festive season and new year,
Danny
Dr Danny Ben-Eli, BSc, MD, FACEM
Emergency Physician | Co-Director of Emergency Medicine Training
Monash Medical Centre | Monash Health
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