Direct Versus Videolaryngoscopy for Emergency Tracheal Intubation of Trauma Patients in Hospital: A Systematic Review.

Abstract

Traumatically injured patients often require emergency intubation of their tracheas. Yet, they present distinct airway challenges, such as anatomic deformities, the need for cervical spine immobilization, diminished physiologic reserve, and logistical hurdles like limited equipment or personnel. In this patient population, both videolaryngoscopy and direct laryngoscopy offer distinct advantages and disadvantages, but current evidence remains inconclusive as to which approach is superior. We conducted a systematic review to determine whether videolaryngoscopy offered higher first-pass success rates than direct laryngoscopy for trauma patients requiring emergency intubation of their tracheas on arrival into the hospital setting. Although the data remain heterogeneous, videolaryngoscopy generally results in noninferior or improved first-pass success rates without significantly increasing complication rates. We conclude that, while providers should choose their initial airway device on an individualized basis, the use of videolaryngoscopy for initial airway management is a reasonable choice for intubation of traumatically injured patients' tracheas, particularly in the presence of cervical spine immobilization.