Science, Medicine, and the Anesthesiologist

In contrast to availability in adults and children, only limited data on the efficacy of video laryngoscopy for neonatal intubation area are available. This single-center trial (tertiary Irish center) randomized neonates (any gestational age) requiring intubation in either the delivery room (29%) or the neonatal intensive care unit (71%) to either video laryngoscopy (N = 107 analyzed) or direct laryngoscopy (N = 107 analyzed). The primary outcome was success on the first intubation attempt. Intubations were performed by pediatric or neonatology residents or a neonatologist; a total of 54 clinicians were involved (trainees compromised 93 to 97% of first attempts). The primary outcome was significantly improved with video laryngoscopy (74% [95% CI, 66 to 82] vs. 45% [95% CI, 35 to 54]; P < 0.001). Of the secondary outcomes, median number of attempts for successful intubation was 1 (95% CI, 1 to 1) versus 2 (95% CI, 1 to 2) respectively. Safety outcomes included median lowest oxygen saturation during intubation 74% (95% CI, 65 to 78) video versus 68% (95% CI, 62 to 74) direct and lowest heart rate 153 beats/min (95% CI, 148 to 158) versus 148 beats/min (95% CI, 140 to 156), respectively.

Take home message: This randomized single-center study involving trainees in pediatrics or neonatology at a tertiary care center demonstrated that first-pass success with use of video laryngoscopy for urgent endotracheal intubation in neonates in the delivery room or neonatal intensive care unit was significantly greater relative to use of direct laryngoscopy.