Video vs Direct Laryngoscopy for Tracheal Intubation After Cardiac Arrest: A Secondary Analysis of the Direct vs Video Laryngoscope Trial.

Summary

In a randomized trial subgroup of 113 adults intubated after cardiac arrest, video laryngoscopy significantly increased first-attempt success (83.3% vs 64.6%) and reduced laryngoscopy time by 50 seconds compared with direct laryngoscopy. These findings provide randomized evidence in the post–cardiac arrest setting to support routine use of video laryngoscopy.

Key Findings

• First-attempt success was higher with video vs direct laryngoscopy (83.3% vs 64.6%; absolute difference 18.7%, 95% CI 1.2–36.2; P=0.03).
• Mean laryngoscopy duration was shorter with video laryngoscopy (48.0 s) than with direct (98.0 s), mean difference −50.0 s (95% CI −86.8 to −13.3; P=0.004).
• Randomized comparison within the cardiac arrest subgroup provides rare trial-level evidence specific to this scenario.

Clinical Implications

Prefer video laryngoscopy for post–cardiac arrest intubation to improve first-pass success and reduce procedure time; ensure training and device availability in EDs and ICUs.

Limitations

• Secondary subgroup analysis with modest sample size (n=113); not powered primarily for cardiac arrest subgroup.
• Single outcome window without longer-term clinical outcomes (e.g., survival, neurologic status).

Future Directions

Confirm findings in a pre-specified, adequately powered RCT focused on cardiac arrest; assess patient-centered outcomes and cost-effectiveness of universal video laryngoscopy deployment.