Written by Jason Lesnick
Spoon Feed
This secondary analysis of the DEVICE RCT found video laryngoscopy (VL) was associated with higher first attempt success and shorter duration of laryngoscopy compared to direct laryngoscopy (DL) in patients in cardiac arrest prior to intubation.
All your DEVICE belong to us
Intubating patients undergoing CPR adds a layer of difficulty to an already high-risk procedure. Time could matter even more in this scenario, as we hope to reverse hypoxemia and hypercarbia and achieve return of spontaneous circulation.
This secondary analysis, performed on patients in cardiac arrest prior to the intubation attempt, analyzed the rates of first attempt success by VL or DL. The parent DEVICE trial was a pragmatic, multicenter, randomized trial of 1,417 critically ill patients at 17 EDs and ICUs in the United States. 113 (7.9%) experienced cardiac arrest prior to intubation. Of these, 87.6% were intubated in the emergency department and 12.4% were intubated in the intensive care unit.
The primary outcome of successful intubation on the first attempt occurred in 40/48 patients (83.3%) in the VL group and 42/65 patients (64.6%) in the DL group (absolute risk difference, 18.7 percentage points; 95%CI, 1.2 to 36.2; P = 0.03).
The mean duration of laryngoscopy was 48 seconds (SD, 37.3) in the VL group and 98 seconds (SD, 122) in the DL group (mean difference, -50 seconds; 95%CI -86.8 to -13.3, P = 0.004).
How will this change my practice?
The authors note that the majority of proceduralists were trainees, which may exaggerate differences between groups. That said, I will continue to reach for a standard geometry VL when intubating in cardiac arrest scenarios, so that if the camera becomes obstructed, I will be able to use the device as a DL.
Source
Video versus Direct Laryngoscopy for Tracheal Intubation Following Cardiac Arrest: a Secondary Analysis of the DEVICE Trial. Chest. 2025 Jan 11:S0012-3692(25)00004-2. doi: 10.1016/j.chest.2024.12.031. Epub ahead of print. PMID: 39805516
