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SYSTEMATIC REVIEW article

Front. Digit. Health
Sec. Health Technology Implementation
Volume 6 - 2024 | doi: 10.3389/fdgth.2024.1373460

Comparing the effectiveness and safety of videolaryngoscopy and direct laryngoscopy for endotracheal intubation in the paediatric emergency department: a systematic review and meta-analysis

Provisionally accepted
Emma Warinton Emma Warinton 1Zubair Ahmed Zubair Ahmed 1,2,3*
  • 1 Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England, United Kingdom
  • 2 Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
  • 3 Surgical Reconstruction and Microbiology Research Centre, National Institute for Health Research (NIHR), Birmingham, United Kingdom

The final, formatted version of the article will be published soon.

    Introduction: Endotracheal intubation is an uncommon procedure for children in the emergency department but can be technically difficult and cause significant adverse effects. Videolaryngoscopy (VL) offers improved first-pass success rates over direct laryngoscopy (DL) for both adults and children undergoing elective surgery. This systematic review was designed to evaluate current evidence regarding how the effectiveness and safety of VL compares to DL for intubation of children in emergency departments.Methods: Four databases (MEDLINE, Embase, CENTRAL and Web of Science) were searched on 11 th May 2023 for studies comparing first-pass success of VL and DL for children undergoing intubation in the emergency department. Studies including adult patients or where intubation occurred outside of the emergency department were excluded. Quality assessment of included studies was carried out using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Meta-analysis was undertaken for first-pass success and adverse event rate.Results: Ten studies met the inclusion criteria representing 5586 intubations. All included studies were observational. Significantly greater first-pass success rate was demonstrated with VL compared to DL (OR 1.64, 95% CI [1.21-2.21], P=0.001). There was no significant difference in risk of adverse events between VL and DL (OR 0.79, 95% CI [0.52-1.20], P=0.27). The overall risk of bias was moderate to serious for all included studies.VL can offer improved first-pass success rates over DL for children intubated in the emergency department. However, the quality of current evidence is low and further randomised studies are required to clarify which patient groups may benefit most from use of VL.

    Keywords: laryngoscopy1, Intubation2, airway management3, Child4, pediatrics5, emergency medicine6, systematic review7

    Received: 19 Jan 2024; Accepted: 30 Aug 2024.

    Copyright: © 2024 Warinton and Ahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Zubair Ahmed, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, England, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.