Comparison of the success rate of endotracheal intubation in the first attempt with a video laryngoscope vs. Macintosh laryngoscope. A qualitative systematic review

Abstract

Background: If the first endotracheal intubation (ETI) maneuver fails, the risk of successive failures and morbidity and mortality increase. It is crucial to make the first attempt under optimal conditions, using the device with the highest probability of success. The universal use of video laryngoscopes would decrease the incidence of Unforeseen Difficult Airway (AV).

Objectives: To synthesize the available evidence on the comparison of the success rate at the first attempt of STI with a video laryngoscope compared to direct laryngoscopy (LD), in adults without predictors of difficulty.

Material and method: Using the criteria of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), the search focused on randomized controlled clinical trials and systematic reviews published up to May 2020.

Sources: PubMed, Cochrane Library, LILACs, Scielo.

Population: Over 16 years of age, undergoing scheduled surgery under general anesthesia performed by anesthesiologists with more than two years of experience.

Intervention: IET with Videolaryngoscope.

Control: IET with Macintosh laryngoscope.

Results and discussion: Two SRs and 4 ECCAs (9908 patients) were included. There is heterogeneity in the studies, their methodologies, designs, definitions and measured variables; and unavoidable biases such as the inability to blind the intervention. The results suggest that video laryngoscopes would be comparable to and not superior to the Macintosh laryngoscope in the first-attempt success rate for non-difficult AS.

Conclusions: There is little evidence of low quality to define the performance of the video laryngoscope in the management of normal AS. It is necessary to continue investigating.