Comparison of video laryngoscopy versus direct laryngoscopy for intubation in emergency department patients with cardiac arrest: A multicentre study

Aim: To compare the tracheal intubation performance between video laryngoscopy (VL) and direct laryngoscopy (DL) in patients with cardiac arrest in the ED. Methods: This is an analysis of the data from a prospective, multicentre study of 15 EDs in Japan. We included consecutive adult patients with cardiac arrest who underwent intubation with VL or DL from 2012 through 2016. The primary outcome was first-attempt success. The secondary outcomes were glottic visualisation assessed with Cormack grade (1 vs. 2-4) and occurrence of oesophageal intubation. To examine the between-device difference in outcome risks, we analysed the whole data and 1:1 propensity score matched data. Results: Among 9694 patients who underwent intubation in the EDs, 3360 cardiac arrests (35%) were included in the analysis (90% were non-traumatic cardiac arrests). The first-attempt success rate was higher in the VL group compared to those in the DL (78% vs 70%; unadjusted OR 1.61 [95% CI 1.262.06] P < 0.001). This association remained significant after adjusting for six potential confounders and within-ED clustering (adjusted OR 1.33 [95% CI 1.03-1.73] P = 0.03). VL use was also associated with a better glottic visualisation (adjusted OR 3.84 [95% CI 2.81-5.26] P < 0.001) and lower rate of oesophageal intubation (adjusted OR 0.45 [95% CI 0.24-0.85] P = 0.01) compared to DL. These results were consistent in the propensity score matched analysis. Conclusions: Based on large multicentre prospective data of ED patients with cardiac arrest, the use of VL was associated with a higher first-attempt success rate compared to DL, with a better glottic visualisation and lower oesophageal intubation rate.