Comparing the Success Rate of using Video Laryngoscope and Direct Laryngoscope for Endotracheal Intubation Among Adult Patients in Prehospital Settings

Abstract

Background: Inserting an endotracheal tube (ETT) is a critical life-saving procedure. The conventional approach is to use direct laryngoscope (DL). While video laryngoscope (VL) has demonstrated enhanced effectiveness, there is a lack of comprehensive evidence comparing the outcomes of VL versus DL in prehospital settings. Aim: Through this dissertation, I aim to evaluate whether using VL compared to DL increases the success rate of endotracheal tube (ETI) among adult patients in prehospital settings. Methods: I conducted a systematic literature search on May 25, 2023, across four databases: Medline, EMBASE, Scopus, and Web of Science. I carefully selected pertinent studies that met my eligibility criteria, including randomised controlled trial (RCT), and adults ≥ 18 years of age requiring prehospital ETI. I excluded hospital-based studies or studies investigating the effectiveness of selected devices on a manikin or cadaveric model. The primary endpoint was an endotracheal intubation success rate between VL and DL. Furthermore, I used the Critical Appraisal Skills Programme (CASP) tool to assess all the included studies. As part of this process, I critically appraised four RCTs in depth. Result: I identified ten studies that matched the eligibility criteria; four were RCTs, and six were observational studies. The combined findings from these studies revealed mixed results. Six studies favoured VL for achieving a higher intubation success rate than DL. In contrast, two studies contradicted this by indicating no significant difference in success rates between VL and DL. Additionally, two other studies suggested that the effectiveness of VL is comparable to DL. Recommendation: I have found that using VL in the prehospital setting is associated with an increased success rate, particularly in patients with constrained neck mobility, restricted mouth opening, and infectious diseases.