Authors' objectives: We identified and summarised evidence addressing the following review question: What is the clinical and cost effectiveness of intubation using video laryngoscopy for people who require airway management in pre-hospital settings?

Authors' results and conclusions: We identified one systematic review and meta-analysis and three randomised control trials (RCTs) comparing video versus direct laryngoscopy in prehospital settings. The overall evidence suggests that the use of video laryngoscopes compared to direct laryngoscopes does not lead to improvements in first-pass intubation success or overall intubation success. We also performed a meta-analysis involving study data for overall and first-pass pass intubation rates across six RCTs. The confidence interval (CI) for both outcomes of individual RCT studies had poor overlap indicating the presence of statistical heterogeneity due to clinical and methodological diversity among the studies. Thus, we performed a sub-group analysis for both outcomes based on the population requiring airway management (i.e., cardiac arrest or major trauma). Studies involving cardiac arrest population suggested that the video laryngoscopy had worse first-pass (I2 = 59%, moderate heterogeneity) and overall intubation success rates (I2 = 97%, considerable heterogeneity) compared to direct laryngoscopy. The only study involving major trauma population suggested that first-pass intubation success rates was higher for video compared to direct laryngoscopy, while the overall intubation success rates did not differ between the two devices. The economic analysis suggests that video laryngoscopes are considerably more expensive than direct laryngoscopes. There is no relative benefit associated with the use of video laryngoscopes and cost minimisation analysis based on providing video laryngoscopes for all out-of-hospital intubations in Wales suggests that video laryngoscopes are not a cost-effective intervention. A scenario of the cost minimisation analysis where video laryngoscopes are used in Emergency Medical Retrieval and Transfer Service (EMRTS) show that video laryngoscopes would remain more expensive, but the additional expense would be lower.

Authors' recommendations: The routine adoption of video laryngoscopy for people who require intubation in a pre-hospital setting is not supported by the evidence. The use of video laryngoscopy does not improve overall intubation success rates and there is no evidence to suggest improved clinical outcomes as compared with direct laryngoscopy. Economic analysis estimates that the routine adoption of video laryngoscopy in a pre-hospital setting would be cost incurring and not cost effective. This recommendation does not preclude the continued use of video laryngoscopy by experts in the pre-hospital setting for patients with difficult airways in services where devices are already available.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this. For the purposes of the meta-analysis and sub-group analysis by population, we used Mantel-Haenszel models for all dichotomous outcomes. A random effects model was used to analyse the pooled data. The results are presented as risk ratios with 95%CI for all outcomes using the Review Manager (RevMan) software for Windows (version 5.4.1, Cochrane Collaboration, 2020). We assessed the statistical heterogeneity using the I2 methodology. I2 values >50% were considered to indicate moderate heterogeneity and >75% considerable heterogeneity among the studies.

Project Status: Completed

Year Published: 2022

URL for published report: https://healthtechnology.wales/reports-guidance/video-laryngoscopes/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales