Table 3.
Outcomes of Tracheal Intubation.
| Outcome | Video Laryngoscope (N = 705) | Direct Laryngoscope (N = 712) | Absolute Difference or Median Difference (95% CI)* |
|---|---|---|---|
| Primary outcome: successful intubation on first attempt — no. (%) | 600 (85.1) | 504 (70.8) | 14.3 (9.9 to 18.7)† |
| Secondary outcome: severe complication during intubation — no. (%)‡ | 151 (21.4) | 149 (20.9) | 0.5 (-3.9 to 4.9) |
| Peripheral oxygen saturation <80% — no./total no. (%)§ | 64/658 (9.7) | 69/659 (10.5) | −0.7 (−4.2 to 2.7) |
| Systolic blood pressure <65 mm Hg — no./total no. (%) | 20/624 (3.2) | 29/644 (4.5) | −1.3 (−3.6 to 1.0) |
| New or increased use of vasopressors — no. (%) | 91 (12.9) | 87 (12.2) | 0.7 (−2.9 to 4.3) |
| Cardiac arrest not resulting in death — no. (%) | 2 (0.3) | 0 | 0.3 (−0.3 to 0.8) |
| Cardiac arrest resulting in death — no. (%) | 1 (0.1) | 3 (0.4) | −0.3 (−1.0 to 0.4) |
| Exploratory procedural outcomes | |||
| Median duration of intubation (IQR) — sec¶ | 38 (26–60) | 46 (30–83) | −8 (−12 to −4) |
| Successful intubation on first laryngoscope blade insertion — no./total no. (%)∥ | 636/704 (90.3) | 546/706 (77.3) | 13.0 (9.1 to 16.9) |
| Successful intubation on first attempt without occurrence of a severe complication — no. (%)** | 484 (68.7) | 420 (59.0) | 9.7 (4.5 to 14.8) |
| Reason for intubation failure on first attempt — no. (%)†† | |||
| Inadequate view of vocal cords | 26 (3.7) | 123 (17.3) | −13.6 (−16.8 to −10.3) |
| Inability to insert an endotracheal tube or bougie | 49 (7.0) | 51 (7.2) | −0.2 (−3.0 to 2.6) |
| Other | 17 (2.4) | 24 (3.4) | −1.0 (−2.8 to 0.9) |
| Not reported | 23 (3.3) | 40 (5.6) | −2.4 (−4.6 to −0.1) |
| Exploratory safety outcomes — no. (%) | |||
| Esophageal intubation | 6 (0.9) | 9 (1.3) | −0.4 (−1.6 to 0.8) |
| Injury to teeth | 3 (0.4) | 2 (0.3) | 0.1 (−0.6 to 0.9) |
| Operator-reported aspiration | 7 (1.0) | 12 (1.7) | −0.7 (−2.0 to 0.6) |
| Exploratory clinical outcomes‡‡ | |||
| Median ICU-free days (IQR) | 20 (0–25) | 19 (0–24) | 1 (−1 to 3) |
| Median ventilator-free days (IQR) | 24 (0–26) | 23 (0–26) | 1 (0 to 2) |
| In-hospital death — no. (%) | |||
| Within 1 hr after randomization§§ | 15 (2.1) | 27 (3.8) | −1.7 (−3.6 to 0.2) |
| Within 28 days after randomization | 184 (26.1) | 191 (26.8) | −0.7 (−5.5 to 4.0) |
The widths of the confidence intervals for the secondary and exploratory outcomes were not adjusted for multiplicity and should not be used to infer definitive differences in treatment effects between the groups.
P<0.001.
Patients could have had more than one severe complication.
Oxygen saturation was measured by pulse oximetry.
Data on the duration of intubation, which was defined as the number of seconds between the start of laryngoscopy and intubation of the trachea, were missing for 28 patients (2.0%): 9 patients in the video-laryngoscope group and 19 patients in the direct-laryngoscope group.
Successful intubation on the first laryngoscope blade insertion refers to successful tracheal intubation during the first laryngoscopy attempt, which was defined as a single insertion of the laryngoscope blade into the mouth, regardless of the number of times a bougie or an endotracheal tube was inserted into the mouth.
Successful intubation on the first attempt without the occurrence of a severe complication was defined as meeting the primary outcome and not the secondary outcome.
Reasons for intubation failure were reported by the operator. Patients could have had more than one reason.
Intensive care unit (ICU)–free days, ventilator-free days, and in-hospital death were assessed at 28 days, with follow-up data censored at the time of hospital discharge.
In-hospital death within 1 hour after randomization was a post hoc outcome.