Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubations: A Randomized Clinical Trial
Authors' conclusion
This randomized clinical trial of DL vs VLM and VLH found that video laryngoscopy significantly improved first-pass success during intubation in the operating room compared with DL.
Study context
- Population
- Adults undergoing surgery under GA with need for tracheal intubation, 6 centres in Germany and Austria2,423 (95.7%) in modified ITT
- Participants
- 2,532 adults
- Comparison
- Video laryngoscopy with Macintosh blade (VLM) or hyperangulated blade (VLH) vs direct laryngoscopy (DL)
- DLn = 848reference
- VLMn = 841
- VLHn = 843
- Primary endpoint
- First-pass intubation success rate (success = positive capnography)
Methodological details3-arm, multicentre, modified ITT
- 3-arm
- Multicentre
- Modified ITT
Primary result
As reported in the abstract
Unadjusted absolute risk difference, percentage points (95% CI)P value
VLM vs DL
4.66(4.45–4.78)
P < 0.001VLH vs DL
9.34(9.22–9.46)
P < 0.001VLH vs VLM
4.68(4.57–4.79)
Further findings
Time to positive capnography after failed first attempt
- Time to positive capnography after failed first attempt: P = .008
Safety
Lip or dental injuries or blood on the blade
- Lip or dental injuries or blood on the blade: denominators 101, 138 and 174
Original publication
Conventional vs Video-Assisted Laryngoscopy for Perioperative Endotracheal Intubations: A Randomized Clinical Trial. JAMA Netw Open. Published 3 August 2026. doi:10.
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