Video laryngoscopy increased rate of successful intubations in neonates, finds study

A recent study published in the New England Journal of Medicine highlighted a critical aspect of neonatal care in endotracheal intubation. This vital procedure is often performed in neonates in the delivery room or neonatal intensive care unit (NICU) and can be fraught with challenges in achieving successful intubation on the first attempt.

The study revealed that repeated attempts at endotracheal intubation in neonates are associated with increased adverse events. Traditionally, clinicians have relied on direct laryngoscopy which helps to visually inspect the airway using a laryngoscope. However, this approach often falls short with fewer than half of first attempts proving successful.

This calls for video laryngoscopy which is equipped with a camera at the tip of the blade that provides a real-time view of the airway on a screen. This technology showed promise in enhancing the success rates of intubation in adults and children, yet, its effectiveness in neonates remained uncertain until now.

The study was conducted at a single center and randomly assigned neonates to either the video-laryngoscopy group or the direct-laryngoscopy group. The results were stratified based on gestational age and the primary outcome measured was successful intubation on the first attempt which was determined by exhaled carbon dioxide detection.

The study analyzed data from 214 neonates in the trial and found that 74% in the video-laryngoscopy group achieved successful intubation on the first attempt when compared to the 45% in the direct-laryngoscopy group. The median number of attempts to achieve successful intubation was significantly lower in the video-laryngoscopy group.

The study also evaluated physiological parameters during intubation. Neonates in the video-laryngoscopy group experienced higher median oxygen saturations and heart rates when compared to the individuals in the direct-laryngoscopy group by indicating potential benefits in terms of patient safety and comfort.

This research underlines the advantages of video laryngoscopy in neonatal intubation procedures. This technology has the potential to revolutionize neonatal care by offering a clearer and more navigable view of the airway, this reduces the need for repeated attempts and minimizing associated risks. Further studies may be imperative to explore long-term outcomes and broader applicability which can add to the existing evidence for the integration of video laryngoscopy into neonatal intensive care units and delivery rooms worldwide.

Reference:

Geraghty, L. E., Dunne, E. A., Ní Chathasaigh, C. M., Vellinga, A., Adams, N. C., O’Currain, E. M., McCarthy, L. K., & O’Donnell, C. P. F. (2024). Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2402785