Topic Status Complete
Video laryngoscopes for use in pre-hospital care.
Outcome of the appraisal
The routine adoption of video laryngoscopy for people who require intubation in a pre-hospital setting is not supported by the evidence.
The use of video laryngoscopy does not improve overall intubation success rates and there is no evidence to suggest improved clinical outcomes as compared with direct laryngoscopy. Economic analysis estimates that the routine adoption of video laryngoscopy in a pre-hospital setting would be cost incurring and not cost effective. This recommendation does not preclude the continued use of video laryngoscopy by experts in the pre-hospital setting for patients with difficult airways in services where devices are already available.
Why was this topic appraised?
Emergency services are required to respond to situations where patients are having difficulty breathing and airway management in the pre-hospital setting is needed.
These are usually situations when there has been either major trauma or cardiac arrest. In some cases, airway management be safely accomplished using basic airway techniques, such as the use of a supraglottic airway, that may provide temporary provision of oxygenation and ventilation. However, in more severe cases, for example following major trauma, the introduction of a breathing tube into the trachea (pre-hospital intubation) is required to ensure that the patient can be safely
transferred to hospital. When intubation is needed, it is acknowledged that ensuring that this is successfully achieved without complications and at the earliest opportunity is a high clinical priority.
During intubation, visualisation of the upper airway (larynx) to allow passage of the tracheal tube is achieved using laryngoscopy. This is usually done using a rigid tool that shines a light into the larynx to provide direct sight of the vocal cords (direct laryngoscopy). However, this can also be achieved using a more flexible device that has a camera incorporated (video laryngoscopy), which relays real-time images onto a display screen. It has been suggested the use of video laryngoscopy in a pre-hospital setting may be associated with higher rates of intubation success and improved patient care.
HTW considered this topic after it was proposed by the Welsh Ambulance Services NHS Trust.
Plain language summary
Anyone who collapses outside of hospital – due to a heart attack, or other emergency events – may need to have a breathing tube fitted before they arrive at A&E.
A video laryngoscope (VL) is a camera that is used to see inside a person’s throat, or larynx. The VL device can be used by Paramedics and First Responders to help fit a breathing tube. The device uses a camera and a monitor. The camera tube is inserted through the nose or mouth and the images are displayed on the monitor. These images are then used to help fit the breathing tube.
HTW looked for evidence on the use of video laryngoscopes to fit breathing tubes in pre-hospital care.