Authors: Garcia-Marcinkiewicz AG et al.
The Lancet, Volume 396, Issue 10266
Summary
This multicentre, parallel-group randomized controlled trial evaluated whether video laryngoscopy using a standard blade improves first-attempt orotracheal intubation success and reduces complications compared with direct laryngoscopy in small infants. Infants without known difficult airway abnormalities requiring intubation in the operating room were enrolled across four quaternary children’s hospitals in the United States and one in Australia. A total of 564 infants were randomized in a 1:1 ratio to video laryngoscopy or direct laryngoscopy, with stratification by site and clinician role.
The primary outcome was successful intubation on the first attempt. Analyses used modified intention-to-treat and per-protocol approaches, accounting for clinician- and site-level clustering and adjusting for gestational age, ASA physical status, weight, clinician role, and institution. Among infants included in the modified intention-to-treat analysis, first-attempt success was higher with video laryngoscopy (93%) than with direct laryngoscopy (88%), corresponding to an adjusted absolute risk difference of 5.5%.
Video laryngoscopy was also associated with improved safety outcomes. Severe complications occurred less frequently in the video laryngoscopy group compared with the direct laryngoscopy group, and oesophageal intubations were significantly reduced with video laryngoscopy. These findings were consistent across analytic approaches and participating centres.
Key Points
• Video laryngoscopy significantly improved first-attempt intubation success in infants.
• Severe complications were less common with video laryngoscopy than with direct laryngoscopy.
• Oesophageal intubations occurred less frequently with video laryngoscopy.
• Benefits were observed using standard blades and routine anesthesia clinicians.
What You Should Know
In anesthetised infants without known difficult airway anomalies, video laryngoscopy offers meaningful advantages over direct laryngoscopy, improving first-attempt success and reducing serious airway complications. These findings support routine consideration of video laryngoscopy as a primary intubation technique in infant anesthesia practice.
Thank you for allowing us to summarize this important trial published in The Lancet.