Acute cardiac care & 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 (RCTs)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. The overall certainty of evidence is very low.
Study context
- Population
- Patients undergoing tracheal intubation during cardiac arrest16 studies (3 randomized controlled trials (RCTs), 13 observational) from 13,031 screened records · three RCTs 331 · Observational studies 29,595
- Comparison
- Tracheal intubation with video laryngoscopy versus direct laryngoscopy during cardiac arrest
- Outcome
- First-pass tracheal intubation success (RCTs)
Methodological detailscommissioned by the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force, randomized controlled trials (RCTs) and non-randomized studies, GRADE certainty of evidence
- Commissioned by the International Liaison Committee on Resuscitation (ILCOR) Advanced Life Support Task Force
- Randomized controlled trials (RCTs) and non-randomized studies
- GRADE certainty of evidence
Pooled result
As reported in the abstract
Relative risk
0.88
95% CI 0.63–1.22
Video laryngoscopyvs direct laryngoscopy
RR 0.88 (95% CI 0.63–1.22)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Overall intubation success (RCTs)Very low-certainty evidence | 1.00 (0.90–1.12) | |
| 0.512Relative risk (log scale) |
First-pass and overall intubation success (observational studies)
- Observational studies generally favored video laryngoscopy for both outcomes
- n = 29,595
Return of spontaneous circulation (ROSC) and survival
- No consistent difference in ROSC or survival (very low-certainty data from observational studies)
Safety
Esophageal intubation
- RCT
- 4.3% vs 0%
- Observational data
- 5.6% vs 1.4%
- 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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