Cardiac arrest & resuscitation
Tracheal intubation using video laryngoscopy as compared to direct laryngoscopy during cardiopulmonary resuscitation: a systematic review and meta-analysis
Pooled result · First-pass tracheal intubation success (3 RCTs, 331 patients)Result — go to the resultRelative risk 0.88 95% CI 0.63–1.22Authors' conclusion
Among adults undergoing tracheal intubation during cardiac arrest, use of video laryngoscopes may improve process outcomes such as first-pass success and reduced esophageal intubation, but there is no evidence of improved ROSC or patient survival.
Study context
- Population
- Patients undergoing tracheal intubation during cardiac arrest16 studies (3 randomized controlled trials (RCTs), 13 observational)
- Comparison
- Video laryngoscopy vs Direct laryngoscopy
- Outcome
- First-pass tracheal intubation success (critical outcome)
Methodological detailsInternational Liaison Committee on Resuscitation (ILCOR)-commissioned, PRISMA, GRADE certainty assessment
- ILCOR-commissioned
- PRISMA
- GRADE certainty assessment
Pooled result
As reported in the abstract
First-pass tracheal intubation success (3 RCTs, 331 patients)
Relative risk
0.88
95% CI 0.63–1.22
Video laryngoscopy vs Direct laryngoscopy
RR 0.88 (95% CI 0.63–1.22)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Overall intubation success (3 RCTs)Very low-certainty evidence | 1.00 (0.90–1.12) | |
| 0.512Relative risk (log scale) |
First-pass and overall intubation success (observational studies, n = 29,595)
- Generally favoured video laryngoscopy for both outcomes
Return of spontaneous circulation (ROSC) and survival (observational studies)
- No consistent difference
- Very low-certainty data
Safety
Esophageal intubation (RCT)
Esophageal intubation (observational data)
- Esophageal intubation (RCT): lower with video laryngoscopy in all studies reporting this outcome
Original publication
Tracheal intubation using video laryngoscopy as compared to direct laryngoscopy during cardiopulmonary resuscitation: a systematic review and meta-analysis. Resuscitation. Published 20 January 2026. doi:10.
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