Comparison of video-stylet and video-laryngoscope for endotracheal intubation in adults with cervical neck immobilisation: A meta-analysis of randomised controlled trials.
Anaesthesia, critical care & pain medicine · 2021-10-21 · Meta-analysis
Abstract
BACKGROUND: The efficacy of video-stylet versus video-laryngoscope for tracheal intubation in patients with cervical spine immobilisation, which is known to impede the intubation process, remains unclear. METHODS: We searched electronic databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library for randomised controlled trials comparing video-stylets with video-laryngoscopes in human subjects with cervical spine immobilisation from inception to the 25th of January 2021. The primary outcome was the rate of successful first-attempt intubation, while secondary outcomes included overall intubation success rate, time for successful intubation, and risk of tissue damage. RESULTS: Five trials (709 patients) published between 2009 and 2020 met the inclusion criteria. There were four types of video-stylets and three types of video-laryngoscopes examined. Hard cervical collar was applied in four studies, while manual inline stabilisation was used in one study for cervical immobilisation. There was no difference in successful first-attempt intubation rate between the video-stylet and the video-laryngoscope groups [risk ratio (RR) = 0.96, 95% CI: 0.90-1.03, p = 0.3; I2 = 47%] (5 trials, 709 patients). The overall success rate (RR = 0.98, 95% CI: 0.96-1.0, p = 0.05; I2 = 0%), intubation time [mean difference (MD) = 5.24, 95% CI: -8.95 to 19.43, p = 0.47; I2 = 92%], and risk of tissue damage (RR = 0.87, 95% CI: 0.26-2.85, p = 0.81; I2 = 39%) were also comparable between the two groups. CONCLUSIONS: This study validates the efficacy of both video-stylets and video-laryngoscopes for tracheal intubation in the situation of cervical spine immobilisation. Further large-scale trials are warranted to support our findings in this clinical setting.
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Tags
Endotracheal intubation · Spinal motion restriction · Video laryngoscopy
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