Comparing Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Critically Ill Adults: A Comprehensive Updated Meta-Analysis and Systematic Review

Abstract Background: Direct laryngoscopy was the modality used in successful trachea intubation. With the advancements in science, video laryngoscopy was introduced to conduct the same procedures with enhancements in viewing glottic views. In emergency settings, both laryngoscopes are commonly used for intubations. This study compares which is more successful in first-attempt tracheal intubation in critically ill patients. Materials and methods: The PubMed database was thoroughly searched for this systematic review and meta-analysis. All RCTs and Observational studies until 2023 were included, whose primary outcome was the first attempt at successful tracheal intubation. The secondary outcomes were severe hypoxemia, severe hypotension, and cardiac arrest. Results: In emergency situations, the success rate of intubation on the first attempt was significantly higher in video laryngoscopy than in direct laryngoscopy. The risk ratio was 1.19 (95% CI 1.10 to 1.29) with a heterogeneity of I2 = 75%. However, there was no significant correlation found between video laryngoscopy and severe hypoxemia, severe hypotension, or cardiac events. The risk ratio for severe hypoxemia was 0.99 (95% CI 0.74 to 1.33), for severe hypotension was 0.19 (95% CI 0.83 to 1.72), and for cardiac events, the risk ratio was 1.17 (95% CI 0.37 to 3.70). The P value was non-significant for these secondary outcomes, indicating that these complications were not associated with video laryngoscopy. The heterogeneity among the secondary outcomes was much lower than that of the primary outcome. It's important to note that there was substantial heterogeneity among the outcomes. Conclusion; our updated meta-analysis has confirmed that video laryngoscopy (VL) has a higher success rate for first-pass intubation than direct laryngoscopy (DL). As a result, we recommend using VL over DL for critically ill patients. Furthermore, our analysis has shown no significant evidence linking VL to any adverse events.