Simulation-based Randomized Paired Cross-over Comparison of Direct versus Video-assisted Laryngoscopy for Endotracheal Intubation by Inexperienced Operators

Purpose: Direct laryngoscopy (DL) is the standard technique for endotracheal intubation. Video-assisted laryngoscopy (VL) has emerged as an alternative, particularly for difficult airway management. Nevertheless, DL and VL have not been systematically compared for simulation-based endotracheal intubation by inexperienced operators. Method: A prospective, randomized cross-over study was carried out at Lund University Faculty of Medicine, Malmö, Sweden, in 50 medical undergraduate students with no previous experience of endotracheal intubation in manikins or patients. Identical manikins (Rescue AnneTM, Laerdal AS, Stavanger, Norway) were consecutively intubated using DL with the Macintosh-type blade, and VL with the hyper-curved GlidescopeTM blade. Similarly designed and extensive instructional films on DL and VL techniques were shown to each study participant immediately before each training session, comprising ten consecutive individual intubation attempts with that specific device. No further instructions or feedback were provided by the study investigators. Results: The VL technique was found to be overall faster than DL, and also associated with fewer intubation failures (P = 0.0209), dental manipulations (P < 0.001), and oesophageal intubations (P < 0.0001). Discussion: Since VL for endotracheal intubation by inexperienced operators was more successful and associated with fewer adverse events than was DL, we propose that VL might be preferable to DL for endotracheal intubation by less experienced users. Further research is however strongly encouraged to validate these findings. © 2019