There has been a lot of discussion around video laryngoscopy (VL) and its superiority or otherwise, over direct laryngoscopy (DL). Previous studies have been small or moderate in size, with only one real multicentre trial. In most trials and in a recent Cochrane review it was found that although VL gave a better view, it wasn’t necessarily better in terms of first attempt intubation success rates. First attempt success is important as failure to intubate at first attempt is associated with potential life-threatening adverse events.
Now, the question is answered. We have the Direct vs Video laryngoscope (DEVICE) Trial, that shows VL’s superiority. Trial enrolment was stopped as the stopping criterion for efficacy was met.
What they did
This was a pragmatic, multicentre, randomised, unblinded, parallel-group trial in which Video laryngoscopy was compared to Direct Laryngoscopy for intubation of critically ill patients. It was conducted in 7 Emergency Departments and 10 ICUs.
There was 1:1 randomisation to DL or VL. There was no specification of brand or blade size or use of stylette or bougie. Those decisions were all left to the operator.
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