Video Laryngoscopy Does Not Improve First-Pass Success in ICU Patients

Richard L. Byyny, MD, MSc, FACEP


In a meta-analysis of randomized, controlled trials, rates of first-pass success and most complications were not significantly better with video laryngoscopy compared with direct laryngoscopy.


These authors performed a meta-analysis of randomized, controlled trials to evaluate the utility of video laryngoscopy (VL) versus direct laryngoscopy (DL) for intubation in the intensive care unit (ICU). Five trials involving 1301 patients met the inclusion criteria. Of these trials, two were performed in medical ICUs, two in combined medical-surgical ICUs, and one in a surgical ICU. GlideScope VL was used in three trials, McGrath MAC VL in one, and a combination of the two methods in one.


In pooled analysis, the first-pass success rate was not improved in the VL group compared with the DL group (relative risk, 1.08). Time to intubation, mortality rate, incidence of difficult intubation, and incidence of hypoxemia were not statistically different between the VL and DL groups. Glottic views were better and the rate of esophageal intubation was lower with VL.




In this large meta-analysis of ICU patients, video laryngoscopy did not improve first-pass success with intubation, contrary to previous findings in emergency department–based studies. Video laryngoscopy is an important tool to have in your armamentarium for intubation, but it is not a panacea. Endotracheal intubation is a cornerstone skill in emergency medicine: It is incumbent on every provider in the emergency department to be facile with several airway techniques and tools.


Huang H-B et al. Video laryngoscopy for endotracheal intubation of critically ill adults: A systemic review and meta-analysis. Chest 2017 Jun 16; [e-pub]. (a href=”″ target=”_blank”>

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