Video beats direct laryngoscopy in first-pass success among ED residents and CCM fellows intubating critically ill patients (DEVICE trial)
Surprisingly, video laryngoscopy (VL) has not consistently been shown to increase first-pass intubation success over direct laryngoscopy (DL) in critically ill patients. Most studies have been small, single center, and only some have favored video.
In the DEVICE trial, 1417 critically ill adults at 17 U.S. emergency departments and ICUs were randomized to undergo either DL or VL for intubation. More than 90% of the intubations were performed by emergency medicine residents (~70%) or critical care fellows (~23%). The trainees were inexperienced in intubation generally (a quarter had done fewer than 25) and direct laryngoscopy (half had done ~70% of their prior intubations by video, and many had done fewer than 20 DL intubations). Various video laryngoscopes were used.
The trial was stopped early when first pass success was achieved in 85% by video laryngoscopy, compared to 71% with direct laryngoscopy. Roughly equal proportions (about 21%) experienced “severe complications” including hyp…
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