From the Guidelines
Training with video laryngoscopy is superior to training with direct laryngoscopy alone for developing intubation skills, as it provides better visualization of airway structures and allows for real-time feedback and correction of technique. Several studies have demonstrated the benefits of video laryngoscopy (VL) training, including a meta-analysis of 9 studies comparing VL with direct laryngoscopy (DL) for intensive care intubation, which found that VL increased the success rate of intensive care intubation at the first attempt [OR 2.07 (IC 95% 1.35–3.16; P < 0.001)] and reduced the incidence of difficult intensive care intubation [OR 0.29 (IC 95% 0.20–0.44; P < 0.001)] 1. Additionally, a recent guideline from the Difficult Airway Society and other organizations recommends the use of videolaryngoscopy for tracheal intubation in patients with suspected or confirmed cervical spine injury, with a moderate recommendation [Grade A; moderate recommendation] 1.
Key Benefits of Video Laryngoscopy Training
- Better visualization of airway structures
- Real-time feedback and correction of technique
- Increased success rate of intensive care intubation at the first attempt
- Reduced incidence of difficult intensive care intubation
- Reduced incidence of oesophageal intubation [OR 0.14 (IC 95% 0.02–0.81; P = 0.03)] 1
Implementation of Video Laryngoscopy Training
- Training programs should include at least 3-5 supervised VL intubations before progressing to DL practice
- Continued supervision until competency is demonstrated with both techniques
- Regular training in the use of videolaryngoscopy with cervical spine immobilisation is recommended [Grade D; weak recommendation] 1
From the Research
Video Laryngoscopy vs Direct Laryngoscopy
- Video laryngoscopy (VL) has been shown to be superior to direct laryngoscopy (DL) in certain clinical scenarios, such as difficult airways 2, 3, 4.
- Studies have demonstrated that VL can decrease the rate of failed intubation and improve the success rate of intubation, especially in novice intubators 2.
- The use of VL has also been associated with a lower number of intubation attempts and a lower frequency of esophageal intubation 5.
Training with Video Laryngoscopy
- Training novices in intubation techniques with VL may be beneficial, as it allows for real-time visualization of the anatomy and simultaneous instructor feedback 6.
- However, the results of studies on the effectiveness of VL training are mixed, and further research is needed to determine the optimal training modality 6.
- One study found that medical students who used VL had improved success rates and faster intubation times compared to those who used DL 2.
Clinical Outcomes
- The use of VL has been associated with improved clinical outcomes, including a higher success rate of intubation, faster intubation times, and a lower frequency of complications such as esophageal intubation 3, 4, 5.
- However, the results of studies on the clinical outcomes of VL vs DL are not uniform, and further research is needed to fully understand the benefits and limitations of VL 5.