Video vs Direct Laryngoscopy for Tracheal Intubation After Cardiac Arrest: A Secondary Analysis of the Direct vs Video Laryngoscope Trial

Authors

Amelia L. Muhs, Vanderbilt University Medical Center, Nashville, TN
Kevin P. Seitz, Vanderbilt University Medical Center, Nashville, TN
Edward T. Qian, Vanderbilt University Medical Center, Nashville, TN
Brant Imhoff, Vanderbilt University Medical Center, Nashville, TN
Li Wang, Vanderbilt University Medical Center, Nashville, TN
Matthew E. Prekker, Hennepin County Medical Center, Minneapolis, MN
Brian E. Driver, Hennepin County Medical Center, Minneapolis, MN
Stacy A. Trent, University of Colorado School of Medicine, Aurora, CO
Daniel Resnick-Ault, University of Colorado School of Medicine, Aurora, CO
Steven G. Schauer, University of Colorado School of Medicine, Aurora, CO
Adit A. Ginde, University of Colorado School of Medicine, Aurora, CO
Derek W. Russell, University of Alabama at Birmingham, Birmingham, AL
Sheetal Gandotra, University of Alabama at Birmingham, Birmingham, AL
David B. Page, University of Alabama at Birmingham, Birmingham, AL
John P. Gaillard, Wake Forest University School of Medicine, Winston-Salem, NC
Lane M. Smith, Wake Forest University School of Medicine, Winston-Salem, NC
Andrew J. Latimer, University of Washington, Seattle, WA
Steven H. Mitchell, University of Washington, Seattle, WA
Nicholas J. Johnson, University of Washington, Seattle, WA
Shekhar A. Ghamande, Baylor Scott & White Healthcare, Temple, TX
Heath D. White, Baylor Scott & White Healthcare, Temple, TX
Kevin W. Gibbs, Wake Forest University School of Medicine, Winston-Salem, NC
Jessica A. Palakshappa, Wake Forest University School of Medicine, Winston-Salem, NC
Derek J. Vonderhaar, LSU Health Sciences Center - New OrleansFollow
David R. Janz, LSU Health Sciences Center - New OrleansFollow
Micah R. Whitson, University of Alabama at Birmingham, Birmingham, AL
Christopher R. Barnes, University of Washington, Seattle, WA
Alon Dagan, Beth Israel Deaconess Medical Center, Boston, MA
Ari Moskowitz, Montefiore Medical Center, The Bronx, NY
et al

Document Type

Article

Publication Date

1-11-2025

Publication Title

Chest

Abstract

BACKGROUND: Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current American Heart Association guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation, but do not provide guidance around intubation methods, including the choice of laryngoscope. RESEARCH QUESTION: Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared with use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest? STUDY DESIGN AND METHODS: This secondary analysis of the Direct vs Video Laryngoscope (DEVICE) trial compared video laryngoscopy vs direct laryngoscopy in the subgroup of patients who were intubated after cardiac arrest. The primary outcome was the incidence of successful intubation on the first attempt. Additional outcomes included the duration of laryngoscopy. RESULTS: Among the 1,417 patients in the DEVICE trial, 113 patients (7.9%) experienced cardiac arrest before intubation, of whom 48 patients were randomized to the video laryngoscopy group and 65 patients were randomized to the direct laryngoscopy group. Successful intubation on the first attempt occurred in 40 of 48 patients (83.3%) in the video laryngoscopy group and in 42 of 65 patients (64.6%) in the direct laryngoscopy group (absolute risk difference, 18.7 percentage points; 95% CI, 1.2-36.2 percentage points; P = .03). The mean duration of laryngoscopy was 48.0 seconds (SD, 37.3 seconds) in the video laryngoscope group and 98.0 seconds (SD, 122.4 seconds) in the direct laryngoscopy group (mean difference, -50.0 seconds; 95% CI, -86.8 to -13.3 seconds; P = .004). INTERPRETATION: Among adults undergoing tracheal intubation after experiencing cardiac arrest, use of video laryngoscopy was associated with increased incidence of successful intubation on the first attempt and shortened duration of laryngoscopy, compared with use of direct laryngoscopy.

PubMed ID

39805516

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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