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Video vs direct laryngoscopy for adults undergoing endotracheal intubation

02 June 2023
Volume 15 · Issue 6


The safety and utility of endotracheal intubation by paramedics in the UK is a matter of debate. Considering the controversy surrounding the safety of paramedic-performed endotracheal intubation, any interventions that enhance patient safety should be evaluated for implementation based on solid evidence of their effectiveness. A systematic review performed by Hansel and colleagues (2022) sought to assess and compare video laryngoscopes against direct laryngoscopes in clinical practice. This commentary aims to critically appraise the methods used within the review by Hansel et al (2022) and expand upon the findings in the context of clinical practice.

Endotracheal intubation (ETI) by paramedics within the UK is a contentious topic. Its place in the scope of paramedic practice is subject to varying opinions regarding its safety and utility (Gregory, 2015). Much of this debate stems from the perceived level of skill and competence required to undertake the procedure and the associated education, training, and assessment processes to determine practitioner competency (Gregory, 2015). It is also recognised that for the majority of UK paramedics, exposure to undertaking ETI in prehospital clinical practice is limited. Robust mechanisms are therefore necessary to monitor and ensure ongoing clinical competency (Gowens et al, 2018).

Given the contention over the safety of ETI by paramedics (Pallin, 2018), any innovations which add to patient safety should be considered for introduction based upon robust evidence of effectiveness. Video laryngoscopy is one such potential innovation, with the addition of electronic camera technologies offering the practitioner improved views of the glottis and, it is inferred, improving success rates (Chemsian et al, 2014).

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