Effect of hyperangulated videolaryngoscopy on first-attempt success in tracheal intubations: A systematic review and meta-analysis.
The American journal of emergency medicine · 2025-08-28 · Meta-analysis
Abstract
OBJECTIVE: To determine whether hyperangulated videolaryngoscopy (HAVL) improves first-attempt success (FAS) in adult orotracheal intubations compared to standard-geometry videolaryngoscopy (SGVL), with a focus on emergency settings. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative observational studies evaluating HAVL versus SGVL in adult tracheal intubations. Comprehensive searches were performed in Ovid MEDLINE, Embase, Cochrane, Scopus, and web of science from inception through November 2024. Risk of bias was assessed using RoB2 and Newcastle-Ottawa tools, and certainty of evidence was rated using GRADE. Both emergency and operating room intubations were included; most emergency data derived from large cohort studies. RESULTS: Of 4445 screened records, 25 studies (17 RCTs, 8 observational; 38,597 patients) were included. HAVL was associated with lower FAS overall (87.2 % vs 91.0 %; pooled RR 0.96, 95 % CI 0.94-0.99; p = 0.002). In emergency intubations (8 studies; n = 34,927), HAVL yielded reduced FAS (RR 0.97, 95 % CI 0.95-0.99; p = 0.003). There was no significant difference in difficult airways (RR 0.98, 95 % CI 0.92-1.05; p = 0.57). HAVL was linked to higher rates of airway trauma (7.5 % vs 2.9 %; RR 1.88, 95 % CI 1.01-3.49; p = 0.046) and numerically more adverse events. Certainty of evidence was low due to risk of bias and heterogeneity. CONCLUSIONS: In emergency intubations, HAVL was associated with lower first-attempt success and increased airway trauma compared to SGVL. These findings support prioritizing SGVL for emergency airway management, with careful operator training if HAVL is used.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Endotracheal intubation · Video laryngoscopy
Related articles
- Video laryngoscopy versus direct laryngoscopy for pediatric emergency tracheal intubation: a systematic review and meta-analysis. (Resusc Plus, 2026)
- Comparison of the Effectiveness of the C-MAC Versus the McGrath Videolaryngoscope for Adult Endotracheal Intubation in Clinical Patients, Simulated Patients, and Manikin Settings: A Systematic Review and Meta-analysis. (Anesthesiol Res Pract, 2026)
- Direct Versus Videolaryngoscopy for Emergency Tracheal Intubation of Trauma Patients in Hospital: A Systematic Review. (Anesth Analg, 2026)
- Video versus direct laryngoscopy for urgent tracheal intubation in neonates: a systematic review and meta-analysis. (Arch Dis Child Fetal Neonatal Ed, 2025)
- Prevalence of Interventions After Difficult Airway Response Team Activation: A Systematic Review and Meta-Analysis. (Respir Care, 2025)
- Comparison of video laryngoscopy with direct laryngoscopy in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. (Eur J Med Res, 2025)