Universal videolaryngoscopy for tracheal intubation in the operating theatre: a prospective non-randomised clinical trial

Abstract

[Abstract] Introduction: Multiple trials have shown the advantages of videolaryngoscopy over direct laryngoscopy for tracheal intubation in the operating theatre. However, the effectiveness of universal videolaryngoscopy in real-world operating theatre settings remains uncertain.

Methods: We conducted a prospective, multicentre, quasi-experimental study, to evaluate the effectiveness of universal videolaryngoscopy compared with direct laryngoscopy for tracheal intubation in a real-world operating theatre setting. During the non-interventional phase, anaesthetists performed tracheal intubation using the Macintosh laryngoscope as their primary tool. In the interventional phase, the same anaesthetists employed a videolaryngoscope as the first-choice device. The primary outcome was 'easy tracheal intubation', defined as a composite of successful tracheal intubation on the first attempt; easy laryngoscopic view; and absence of the need for adjunct airway devices.

Results: Of the 5135 patients included in the study, easy tracheal intubation occurred in 1909/2568 patients (74.3%) during the non-interventional phase compared with 2216/2567 patients (86.3%) during the interventional phase (absolute difference 12%, 95%CI 9.8-14.1, p < 0.001). The interventional phase showed higher rates of successful first-attempt tracheal intubation (absolute risk difference 5.8%, 95%CI 4.1-7.5, p < 0.001); easy laryngoscopy (absolute risk difference 9.9%, 95%CI 8.2-11.7, p < 0.001); and a lower need for adjunct airway devices (absolute risk difference -5.2%, 95%CI -6.7 to -3.7, p < 0.001). Additionally, complications related to tracheal intubation were reduced significantly in the interventional phase (absolute risk difference -4.3%, 95%CI -5.7 to -2.8, p < 0.001).

Discussion: In a real-world operating theatre setting, universal videolaryngoscopy was effective at increasing the rate of easy tracheal intubation and successful first-attempt tracheal intubation, while reducing the incidence of difficult laryngoscopy and complications related to tracheal intubation.