166 - A Meta-Analysis of Hyperangulated vs Standard Geometry Video Laryngoscopy for First Pass Success
Wednesday, May 13, 2020
1:24 PM – 1:32 PM
Location: Terrace: Terrace Level
Participants should be aware of the following financial/non-financial relationships:
Austin J. Parish, MD, MS: No disclosure data submitted.
Jason R. West, MD, MD: Nothing to disclose
Background and Objectives: Previous meta-analyses have addressed how video laryngoscopy (VL) vs direct laryngoscopy (DL) affect the rates of first endotracheal tube pass success (FPS) outside the operating room theater. It is unknown how VL blade geometry, hyperangulated video laryngoscopy (HA-VL) or standard geometry video laryngoscopy (STD-VL), affects the outcome of FPS. Our objective was to perform the first meta-analysis to determine the effect of the angulation of a VL blade versus a DL blade for the outcome of FPS in the ED and ICU settings.
Methods: We searched PubMed, EMBASE, Scopus, and CENTRAL databases from 2006 until 2019 without language restriction using search terms aided by a librarian. We included randomized controlled trials, prospective studies, and retrospective studies comparing the specific angulation of a VL blade vs DL for the outcome of FPS in the ED and ICU. Meta-analysis was performed using the Sidik and Jonkman random-effects model; and the results are reported as pooled odds ratios (OR) with 95% CI and heterogeneity assessments. Network meta-analysis for the indirect comparison of HA-VL vs STD-VL for FPS was carried out using frequentist techniques.
Results: 2,464 studies were screened, and 30 studies underwent full text review. 6 studies were excluded for the combined use of HA-VL and STD-VL blades; 3 studies were excluded for not reporting the angulation of the VL blade; 2 studies were excluded for not reporting FPS; and one study was excluded for not comparing VL to DL. 18 studies (10,858 patients) were included in the meta-analysis. Among the 11 HA-VL vs DL studies (8,219 patients), the OR for FPS was 1.71 (95%CI 1.14 - 2.58; I2=86%). Among the 6 STD-VL vs DL studies (2,176 patients), the OR for FPS was 1.56 (1.11 - 2.19; I2=60%). One additional study (466 patients) comparing ED HA-VL vs STD-VL was included in the network meta-analysis. Using a frequentist network meta-analysis including 18 pairwise comparisons, 18 studies, and 3 treatments; the indirect comparison of HA-VL vs STD-VL for FPS yielded an OR of 1.03 (95%CI 0.61 - 1.72; I2=81%).
Conclusion: This novel meta-analysis showed that both HA-VL and STD-VL blades have a higher OR for FPS compared to DL in the ED and ICU settings. Using indirect comparison network meta-analysis, there did not seem to be a significant difference between HA-VL and STD-VL for the achievement of FPS. Future studies should target the performance between the HA-VL and STD-VL blades.