Pediatric video laryngoscope versus direct laryngoscope: a meta‐analysis of randomized controlled trials

Summary Background We reviewed the updated literature and performed a meta‐analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes ( VL s) and direct laryngoscopes ( DL s). Methods We searched articles published in English matching the key words ‘video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS , Bullard, McGrath)’ AND ‘direct laryngoscope’ AND ‘children (including pediatric, infant, neonate)’ in PubMed, Ovid, Google Scholar, and the Cochrane Library databases. Only prospective randomized controlled trials ( RCT s), which compared the use of VL s and DL s in children, were included. The relative risk ( RR ), weighted mean difference ( WMD ), and their corresponding 95% confidence interval (95% CI ) were calculated using the quality effects model of the metaxl 1.3 software for outcome data. Results Fourteen studies were included in this meta‐analysis. Although VL s improved the glottis visualization in most children either with normal airways or with potentially difficult intubations, the time to intubation ( TTI ) was prolonged in comparison to DL s ( WMD : 4.9 s; 95% CI : 2.6–7.1). Subgroup analysis showed the GlideScope ( WMD : 5.2 s; 95% CI : 2.0–8.5), TruView ( WMD : 5.1 s; 95% CI : 0.7–9.5), Storz ( WMD : 6.4 s; 95% CI : 4.8–8.1), and Bullard ( WMD : 37.5 s; 95% CI : 21.0–54.0) rather than Airtraq ( WMD : 0.6 s; 95% CI : −7.7–8.9) prolonged TTI . Although the success rate of the first attempt ( RR : 0.96; 95% CI : 0.92–1.00) and associated complications ( RR : 1.11; 95% CI : 0.39–3.16) were similar in both groups, VL s were associated with a higher incidence of failure ( RR : 6.70; 95% CI : 1.53–29.39). Conclusion This meta‐analysis demonstrates that although VL s improved glottis visualization in pediatric patients, this was at the expense of prolonged TTI and increased failures. However, further studies are needed to clarify the efficacy and safety of VL s in hands of nonexperts and in children with airway problems.