What is the role of video-assisted laryngoscopy (VAL) in rapid sequence intubation (RSI)?

Updated: Apr 07, 2020
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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VAL offers the advantage of abandoning the need for alignment of the optical axes in the mouth, pharynx, and larynx in order to visualize the entrance of the glottis and therefore is more effective. Unfortunately, standard ETTI via DL, performed by untrained medical personnel and those who perform it only occasionally, carries a high risk of failure. In several studies looking at the success rate of ETTI via DL performed by medical support staff, medical students, and novice anesthesia residents, the initial success rate varied between 35% and 65%. It has been shown that in order to improve the success rate of DL to over 90%, one would require about 47-56 intubations. [51] In stark contrast, VAL has been shown to be easily learned and highly successful with minimal training necessary. A prospective trial compared 37 novice residents in VAL versus DL and found that the former yielded a 14% higher success rate and 14% fewer esophageal intubations. [52] Nouruzi-Sedeh et al evaluated medical personnel with no prior experience in ETTI (paramedic students, nurses, and medical students) and after a brief didactic/manikin session compared their laryngoscopy skills in the operating room between VAL and DL. As in many other similar studies, they showed that VAL led to a significantly higher success rate (93%) compared with DL (51%) in nonphysicians with no prior laryngoscopy experience. Subjects were also noted to have a dramatic improvement after only five ETTIs; they neared a 100% success rate using VAL. [53] A meta-analysis looked at VAL compared with DL in 17 trials with 1,998 patients. The pooled relative risk for nondifficult intubations was 1.5 and for difficult intubations was 3.5; the authors concluded that VAL improves glottic visualization, particularly in patients with potentially difficult airways. [54]

VAL is now available as both a portable unit that is attached to a laryngoscope and as a stand-alone unit that is wheeled to the bedside. Utilization is often one of personal preference or institutional availability.

See the images and video below.

Set up for video-assisted laryngoscopy. Used with Set up for video-assisted laryngoscopy. Used with permission from Springer Publishing Company.
Video demonstration of the ease of video-assisted laryngoscopy in aligning the oral, pharyngeal, and laryngeal airway axis and glottic view. Used with permission from Springer Publishing Company.
Glottic view via video-assisted laryngoscopy. Used Glottic view via video-assisted laryngoscopy. Used with permission from Springer Publishing Company.

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