Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants

Lucy E Geraghty; Emma A Dunne; Caitríona M Ní Chathasaigh; Akke Vellinga; Niamh C Adams; Eoin M O'Currain; Lisa K McCarthy; Colm P F O'Donnell

doi:10.1056/NEJMoa2402785

Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants

N Engl J Med. 2024 May 5. doi: 10.1056/NEJMoa2402785. Online ahead of print.

Authors

Lucy E Geraghty¹, Emma A Dunne¹, Caitríona M Ní Chathasaigh¹, Akke Vellinga¹, Niamh C Adams¹, Eoin M O'Currain¹, Lisa K McCarthy¹, Colm P F O'Donnell¹

Affiliation

¹ From the Departments of Neonatology (L.E.G., E.A.D., C.M.N.C., E.M.O., L.K.M., C.P.F.O.) and Radiology (N.C.A.), National Maternity Hospital, and the School of Medicine (L.E.G., C.M.N.C., E.M.O., L.K.M., C.P.F.O.) and the Centre for Support and Training in Analysis and Research (CSTAR), School of Public Health, Physiotherapy, and Sports Science (A.V.), University College Dublin - both in Dublin.

PMID: 38709215
DOI: 10.1056/NEJMoa2402785

Abstract

Background: Repeated attempts at endotracheal intubation are associated with increased adverse events in neonates. When clinicians view the airway directly with a laryngoscope, fewer than half of first attempts are successful. The use of a video laryngoscope, which has a camera at the tip of the blade that displays a view of the airway on a screen, has been associated with a greater percentage of successful intubations on the first attempt than the use of direct laryngoscopy in adults and children. The effect of video laryngoscopy among neonates is uncertain.

Methods: In this single-center trial, we randomly assigned neonates of any gestational age who were undergoing intubation in the delivery room or neonatal intensive care unit (NICU) to the video-laryngoscopy group or the direct-laryngoscopy group. Randomization was stratified according to gestational age (<32 weeks or ≥32 weeks). The primary outcome was successful intubation on the first attempt, as determined by exhaled carbon dioxide detection.

Results: Data were analyzed for 214 of the 226 neonates who were enrolled in the trial, 63 (29%) of whom were intubated in the delivery room and 151 (71%) in the NICU. Successful intubation on the first attempt occurred in 79 of the 107 patients (74%; 95% confidence interval [CI], 66 to 82) in the video-laryngoscopy group and in 48 of the 107 patients (45%; 95% CI, 35 to 54) in the direct-laryngoscopy group (P<0.001). The median number of attempts to achieve successful intubation was 1 (95% CI, 1 to 1) in the video-laryngoscopy group and 2 (95% CI, 1 to 2) in the direct-laryngoscopy group. The median lowest oxygen saturation during intubation was 74% (95% CI, 65 to 78) in the video-laryngoscopy group and 68% (95% CI, 62 to 74) in the direct-laryngoscopy group; the lowest heart rate was 153 beats per minute (95% CI, 148 to 158) and 148 (95% CI, 140 to 156), respectively.

Conclusions: Among neonates undergoing urgent endotracheal intubation, video laryngoscopy resulted in a greater number of successful intubations on the first attempt than direct laryngoscopy. (Funded by the National Maternity Hospital Foundation; VODE ClinicalTrials.gov number, NCT04994652.).

Associated data

ClinicalTrials.gov/NCT04994652