The Benefits of a Video Laryngoscope

The Benefits of a Video Laryngoscope

Advantages of video laryngoscopes

Advances in medical technology and techniques have a great impact on the outcome of patients.  Starting around 2001 a number of companies started introducing Video Laryngoscope technology into the market that promised better outcomes.  In the initial adoption phases, there were a number of challenges for all parties involved.  Product cost, quality, training, usage, and maintenance all played a role in a cautious industry-wide adoption.   Introducing new treatment protocols requires a lot of study and testing but it also requires getting past common objections. When it comes to promoting the benefits of a video laryngoscope it was the human factor that needed to be addressed.  

Fast forward to today and this transition has been completed.  Most leading practitioners and emergency response teams now utilize video laryngoscopes in their medical tool kit as a preferred intubation method.   Below we will talk about these benefits and why the industry is moving to this technology. 

Video Laryngoscope in Surgery
Video Laryngoscope in Surgery

3 Significant Video Laryngoscope Advantages

Using a video laryngoscope offers several benefits compared to a traditional manual laryngoscope.

  1. Video laryngoscopes provide enhanced visualization of airway structures during intubation. The inclusion of a camera and screen allows healthcare professionals to view a real-time magnified image of the larynx and vocal cords, enabling a better view of anatomical landmarks and potential obstructions. This improved visualization can lead to increased first-pass success rates, reducing the need for multiple attempts and minimizing patient discomfort.
  2. Video laryngoscopes can be particularly advantageous in difficult airway management scenarios. They offer a better view of the glottis, making it easier to navigate anatomical variations, limited mouth opening, or situations with poor visualization due to blood, secretions, or edema. This can help in identifying and addressing airway challenges promptly, reducing the risk of complications and improving patient safety.
  3. Video laryngoscopes may be particularly useful in certain patient populations, such as those with restricted neck mobility or suspected cervical spine injuries. The ability to maintain a better alignment of the airway axis during intubation attempts can minimize the potential movement of the cervical spine and reduce the associated risks.

Supporting Clinical Studies

Since 2010 numerous clinical studies and article have been done that shows the effectiveness of utilizing video screen technology to improve emergency, surgical, and difficult intubation outcomes versus traditional methods.  This is especially true for younger, less experienced, or professionals that are new to the field.  Most studies conclude that first-attempt success is improved as well as faster intubation, less patient trauma, and better overall outcomes.  The three studies below are examples of recent findings.

  1. Title: Comparison of video laryngoscopy versus direct laryngoscopy for tracheal intubation in adults: a meta-analysis of randomized controlled trials.
    Source: European Journal of Anaesthesiology
    Year Published: 2017
    Primary Authors: Lewis SR, Butler AR, Parker J, et al.
    Reference: PubMed Link
    Summary: This article focuses on the comparison of video laryngoscopy versus direct laryngoscopy for tracheal intubation in adults. It presents a systematic review and meta-analysis of randomized controlled trials, examining the success rates and potential complications associated with each technique. The study concludes that video laryngoscopy may have higher success rates and lower rates of esophageal intubation compared to direct laryngoscopy.
  2. Title: A randomized controlled trial of McGrath MAC X-blade video laryngoscope versus Macintosh laryngoscope for endotracheal intubation by novice intubators in patients with immobilized cervical spine.
    Source: Journal of Anaesthesiology Clinical Pharmacology
    Year Published: 2021
    Primary Authors: Goyal R, Das A, Bang A, et al.
    Reference: PubMed Link
    Summary: This study investigates the use of McGrath MAC X-blade video laryngoscope versus the Macintosh laryngoscope for endotracheal intubation in patients with immobilized cervical spine. It is a randomized controlled trial conducted by novice intubators. The study compares intubation success rates and the occurrence of complications between the two laryngoscope types. It provides insights into the efficacy of video laryngoscopy in specific patient populations.
  3. Title: Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis.
    Source: Critical Care
    Year Published: 2016
    Primary Authors: Choi HJ, Kim YB, Kang HG, et al.
    Reference: PubMed Link
    Summary: This article reports on a randomized controlled trial comparing video laryngoscopy and direct laryngoscopy for endotracheal intubation of critically ill patients. The study aims to evaluate intubation success rates, duration, and complications associated with each technique in the critical care setting. The findings suggest that video laryngoscopy may result in higher intubation success rates and faster intubation times compared to direct laryngoscopy in this patient population.

Intubation Speed

It almost goes without saying that every second counts in an emergency medical setting. The reason to mention it is to quantify the difference between hurrying and effective time use. Medical staff fight an ever-changing landscape with each patient and each intubation they perform, in many cases the fastest intubation isn’t always the safest intubation, so it is important to be both fast and “done right”.  There is a difference, then, between forcing something and getting it done safely.

A video laryngoscope can potentially improve the speed of intubation compared to a traditional laryngoscope. The enhanced visualization provided by a video laryngoscope allows for better identification of the larynx and vocal cords, facilitating quicker and more accurate placement of the endotracheal tube.

With a traditional laryngoscope, the direct line of sight to the airway structures can be limited, especially in patients with challenging airways. This can sometimes result in difficulties in visualizing the vocal cords and necessitate multiple attempts for successful intubation. In contrast, a video laryngoscope provides a clear, magnified view of the airway on a screen, allowing the operator to more easily navigate the anatomy and guide the endotracheal tube into the correct position.

The improved visualization offered by video laryngoscopy can lead to a higher first-pass success rate, reducing the need for repeated intubation attempts. This, in turn, can help save time during intubation procedures, particularly in critical or emergency situations where time is of the essence.

However, it’s important to note that the speed of intubation can also be influenced by various factors, such as the operator’s skill and experience, patient factors, and the specific clinical scenario. While video laryngoscopy has the potential to improve intubation speed, it is crucial for healthcare professionals to receive proper training and practice to effectively utilize the device and optimize their intubation techniques.

Precision

Whether done quickly or slowly, getting a tube through the trachea without causing damage to the larynx and vocal cords isn’t always easy. Patients rarely remain still for procedures, let alone invasive ones, let alone when they are panicking. 

Working with video offers a zoomed-in view that illustrates smaller blockages and increases the accuracy of timing for pushing through between compressions or other team actions.

For training purposes, a video laryngoscope is far easier to use and learn than a direct scope. Direct scopes are cheaper and more widely available, they also offer better practice to get a ‘feel’ for intubation procedures. 

It is like the metaphor of swinging with ten bats to build up muscle to hit a home run. Precision beats brute force. Learning a slower, more archaic technique makes little sense.

To put it another way, it’s difficult to test if it is simply experience that makes for better intubation or knowledge of varied techniques.

Team Coordination

In general, the learning curve for successful intubation with a video laryngoscope is shorter than direct scopes.  Junior team members working with a scope feel more confident when they can more clearly see what they are doing.  That a video laryngoscope can be used from more angles also helps to facilitate movement and positioning inside of a crowded procedure room.  In addition, intubation is often done during other resuscitation efforts and settings.  A team that can see the intubation process gains the advantage of faster adjustments to rhythms of compressions and physical repositioning attempts. 

The screen, visible to multiple team members, offers a clearer feedback loop than a direct scope. It is important that auditory calls still be made and that team members not become transfixed by looking at the screen. Advice on changes to positioning or ways to clear the field is easier when each member that needs information doesn’t have to take a look in a direct scope or translate descriptions.

This technology enhances the education and training of healthcare professionals by allowing observation and guidance from experienced practitioners, facilitating skill development and promoting a collaborative learning environment. The captured video recordings can also be used for debriefing, analysis, and continuous quality improvement in airway management practices.

Record Keeping

A video laryngoscope can significantly improve record keeping and organization of cases in airway management. Here are a few ways it facilitates this process:

  1. Video Documentation: Video laryngoscopes allow for the recording of intubation procedures. This feature enables healthcare professionals to capture the entire process, including the visualization of airway structures, intubation attempts, and any complications encountered. These video recordings serve as valuable documentation of the procedure and can be used for later review, analysis, and educational purposes.
  2. Case Review and Education: The recorded videos can be utilized for case review sessions, where healthcare professionals can analyze their techniques, evaluate the effectiveness of different approaches, and identify areas for improvement. Video review sessions provide an opportunity for constructive feedback, continued learning, and enhancing future intubation skills. Additionally, the recorded cases can be shared with colleagues or used for educational purposes to demonstrate proper intubation techniques or showcase challenging airway scenarios.
  3. Quality Improvement and Research: Video recordings from multiple cases can be compiled for quality improvement initiatives and research studies. Analyzing a collection of cases can help identify patterns, assess success rates, evaluate the impact of different techniques or equipment, and gather data for research purposes. These recordings can contribute to the development of best practices, guidelines, and advancements in airway management.
  4. Medico-Legal Documentation: In situations where there are concerns or disputes regarding intubation procedures, the video recordings can serve as objective evidence of the events that took place. They can provide valuable documentation for medico-legal purposes, assisting in the accurate representation of the procedure and aiding in potential investigations or evaluations.

Cost Efficacy

When comparing the overall initial and lifetime costs of a video laryngoscope with traditional laryngoscopes, several factors should be considered, including the potential cost savings associated with reducing risks, injuries, errors, and insurance.

Initial Costs: Video laryngoscopes generally have a higher upfront cost compared to traditional laryngoscopes. The advanced technology and additional components, such as cameras and screens, contribute to the higher price. Traditional laryngoscopes, on the other hand, are simpler in design and typically more affordable. However, it’s important to consider the long-term benefits and potential cost savings that video laryngoscopy can provide.

Lifetime Costs: While the initial investment for video laryngoscopes may be higher, they can potentially lead to cost savings over their lifetime. Video laryngoscopy offers improved visualization, which can reduce the risk of complications, intubation errors, and related injuries. This can lead to decreased healthcare costs associated with managing complications, treating injuries, or addressing adverse events caused by intubation difficulties.

Opportunity Cost of Risk and Errors: The opportunity cost of risk and errors associated with traditional laryngoscopy can be significant. Failed intubation attempts or complications can result in increased healthcare expenditures, extended hospital stays, and potential legal implications. Video laryngoscopes can help mitigate these risks by providing better visualization, increasing first-pass success rates, and reducing the potential for complications. By minimizing adverse events and associated costs, video laryngoscopy can offer long-term cost savings.

Insurance Considerations: Insurance premiums for healthcare professionals and facilities can be affected by the risk profile associated with different intubation techniques. Higher-risk procedures, such as those utilizing traditional laryngoscopes, may result in increased insurance costs due to the potential for adverse events. By adopting video laryngoscopy, which can improve safety and reduce the likelihood of complications, healthcare providers may be able to negotiate lower insurance premiums over time.

It’s important to note that the overall cost comparison between video laryngoscopes and traditional laryngoscopes may vary depending on factors such as the specific models and brands, the frequency of use, and the specific healthcare setting. Conducting a thorough cost analysis, considering both direct costs and potential cost savings, is recommended to determine the most suitable option for a particular healthcare facility or practitioner.

Its Time to Get Clarity

As we can see, the benefits of using video laryngoscopes include improved visualization, increased first-pass success rates, better management of difficult airways, enhanced educational opportunities, and improved safety in specific patient populations. These advantages contribute to more effective and efficient airway management, ultimately leading to improved patient outcomes.  If you are considering adding to or upgrading your fleet of intubation devices now is a great time to do it, the technology is mature and provides clear benefits.

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