Videolaryngoscopy versus direct laryngoscopy for teaching direct laryngoscopy skills: a systematic review and meta-analysis.

Abstract

It is established that videolaryngoscopy improves intubation success rates and views compared with direct laryngoscopy. However, concerns regarding default adoption of videolaryngoscopy include a negative impact on skill acquisition for direct laryngoscopy. This study aimed to assess the utility of Macintosh videolaryngoscopy for teaching direct laryngoscopy. We systematically searched MEDLINE and Embase databases for relevant randomised controlled trials, crossover, and observational studies. Two authors screened abstracts and full-text manuscripts for inclusion before extracting and cross-checking data. Critical outcomes included first-attempt success, overall success, and time to intubation, with trainee confidence and ease of guidance assessed as secondary outcomes. Meta-analysis was performed using random-effects models. Risk of bias was assessed using the Cochrane RoB-2 tool. We identified 21 relevant studies, 10 of which assessed Macintosh videolaryngoscopy for teaching direct laryngoscopy. For first-attempt success, videolaryngoscopy outperformed direct laryngoscopy with a risk ratio (RR) of 1.16 ([95% confidence interval 1.07-1.25]; five studies; I²= 17%). Overall intubation success did not differ significantly between videolaryngoscopy and direct laryngoscopy training (RR 1.05 [0.99-1.12]; seven studies; I²=27%) and neither did time to successful intubation (mean difference -7.4 s [-15.8 s to 0.9 s]; seven studies; I²=73%). All but two studies raised concern for risk of bias in at least one domain. Limitations included small sample sizes and heterogeneous data presentation. Sensitivity analyses favoured videolaryngoscopy. Videolaryngoscopy appears to be an effective tool for teaching direct laryngoscopy. Its role as a preferred teaching tool should be considered. PROSPERO (CRD42023493366).