Video Laryngoscopy Is Superior to Direct Laryngoscopy for Failed Intubation Attempts in the ER
Although video laryngoscopy has repeatedly been shown to be superior to direct laryngoscopy, there has not yet been any specific directive instructing emergency department (ED) intubators to use video laryngoscopy primarily. In a study of adult intubations at a single ED over a 5-year period, researchers compared second-attempt (rescue) success rates with the C-MAC video laryngoscope (VL) versus a direct laryngoscope (DL). The authors included only intubations in which the same operator performed the initial and second attempt.
Among 398 cases, the C-MAC was used for the second attempt in 141 and the DL in 94. Success rates were higher when the second attempt was performed with the C-MAC than the DL (82% vs. 62%). Findings were similar after adjustment for potential confounders and regardless of which device was used initially. Among patients whose first attempt had been with a C-MAC, success rates were 85% when the second attempt was also performed with a C-MAC, versus 50% with a DL. Similarly, among patients whose first attempt had been with a DL, second attempts were successful in 78% with the C-MAC versus 63% with a DL.
Although some people argue that every intubation should be performed with video laryngoscopy, I disagree. I still firmly believe that ER and hospital physicians must retain the skill to intubate a patient using direct laryngoscopy. This is important if you are ever in a situation where you do not have a video laryngoscope available and in cases of mechanical failure of the video laryngoscope.
I do tend to grab for the video laryngoscope after an initial failed intubation attempt.