Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients–a systematic review and meta-analysis

Jia Jiang; Na Kang; Bo Li; An-Shi Wu; Fu-Shan Xue

doi:10.1186/s13049-020-0702-7

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Table 4 Results of meta-analysis for all adverse events between direct laryngoscope and video laryngoscope

From: Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients–a systematic review and meta-analysis

Outcomes	Studies, N	Participants, N	Heterogeneity	Heterogeneity Statistical method	Effect Estimate	P values
Rate of EI	18	11,187	P = 0.05; I² = 39%	RR (M-H, Fixed, 95% CI)	0.24 [0.18, 0.32]	P < 0.01
Rate of EI (RCT)	7	1232	P = 0.70; I² = 0%	RR (M-H, Fixed, 95% CI)	0.27 [0.13, 0.57]	P < 0.01
Rate of EI (non-RCT)	11	9955	P = 0.01; I² = 57%	RR (M-H, Fixed, 95% CI)	0.24 [0.18, 0.32]	P < 0.01
Rate of EI (CPR)	4	3723	P = 0.44; I² = 0%	RR (M-H, Fixed, 95% CI)	0.27 [0.15, 0.49]	P < 0.01
Rate of EI (non-CPR)	15	7464	P = 0.03; I² = 46%	RR (M-H, Fixed, 95% CI)	0.23 [0.17, 0.31]	P < 0.01
Rate of EI (experienced)	5	1100	P = 0.45; I² = 0%	RR (M-H, Fixed, 95% CI)	0.44 [0.17, 1.15]	P = 0.09
Rate of EI (inexperienced)	12	9807	P = 0.02; I² = 50%	RR (M-H, Fixed, 95% CI)	0.23 [0.17, 0.31]	P < 0.01
Rate of EI (unknown expertise)	1	280	Not applicable	RR (M-H, Fixed, 95% CI)	0.38 [0.02, 6.94]	P = 0.51
Incidence of hypoxemia	4	1548	P = 0.35; I² = 8%	RR (M-H, Fixed, 95% CI)	0.85 [0.69, 1.05]	P = 0.14
Incidence of hypoxemia (RCT)	2	510	P = 0.34; I² = 0%	RR (M-H, Fixed, 95% CI)	0.91 [0.56, 1.47]	P = 0.70
Incidence of hypoxemia (non-RCT)	2	1038	P = 0.13; I² = 56%	RR (M-H, Fixed, 95% CI)	0.83 [0.66, 1.05]	P = 0.13
Incidence of hypoxemia (experienced)	2	393	P = 0.70; I² = 0%	RR (M-H, Fixed, 95% CI)	1.05 [0.77, 1.43]	P = 0.76
Incidence of hypoxemia (inexperienced)	2	1155	P = 0.89; I² = 0%	RR (M-H, Fixed, 95% CI)	0.71 [0.53, 0.96]	P = 0.03
Incidence of severe hypoxemia	8	1739	P = 0.26; I² = 22%	RR (M-H, Fixed, 95% CI)	1.13 [0.83, 1.52]	P = 0.44
Incidence of severe hypoxemia (RCT)	4	787	P = 0.18; I² = 39%	RR (M-H, Fixed, 95% CI)	1.11 [0.66, 1.87]	P = 0.39
Incidence of severe hypoxemia (non-RCT)	4	952	P = 0.26; I² = 26%	RR (M-H, Fixed, 95% CI)	1.13 [0.78, 1.64]	P = 0.52
Incidence of severe hypoxemia (experienced)	2	393	P = 0.46; I² = 0%	RR (M-H, Fixed, 95% CI)	1.16 [0.62, 2.16]	P = 0.65
Incidence of severe hypoxemia (inexperienced)	6	1346	P = 0.14; I² = 40%	RR (M-H, Fixed, 95% CI)	1.12 [0.79, 1.58]	P = 0.53
Incidence of aspiration	13	4634	P = 0.98; I² = 0%	RR (M-H, Fixed, 95% CI)	0.83 [0.60, 1.16]	P = 0.28
Incidence of aspiration (RCT)	7	1751	P = 0.79; I² = 0%	RR (M-H, Fixed, 95% CI)	0.90 [0.52, 1.58]	P = 0.72
Incidence of aspiration (non-RCT)	6	2883	P = 0.92; I² = 0%	RR (M-H, Fixed, 95% CI)	0.80 [0.53, 1.21]	P = 0.28
Incidence of aspiration (CPR)	1	140	Not applicable	RR (M-H, Fixed, 95% CI)	5.58 [0.25, 126.46]	P = 0.28
Incidence of aspiration (non-CPR)	13	4494	P = 0.97; I² = 0%	RR (M-H, Fixed, 95% CI)	0.83 [0.59, 1.16]	P = 0.27
Incidence of aspiration (experienced)	6	1769	P = 0.88; I² = 0%	RR (M-H, Fixed, 95% CI)	0.65 [0.32, 1.32]	P = 0.24
Incidence of aspiration (inexperienced)	7	2865	P = 0.92; I² = 0%	RR (M-H, Fixed, 95% CI)	0.90 [0.61, 1.31]	P = 0.57
Incidence of new-onset CA	7	2433	P = 0.20; I² = 31%	RR (M-H, Fixed, 95% CI)	1.52 [0.63, 3.66]	P = 0.35
Incidence of new-onset CA (RCT)	4	795	P = 0.56; I² = 0%	RR (M-H, Fixed, 95% CI)	3.51 [0.73, 16.92]	P = 0.12
Incidence of new-onset CA (non-RCT)	3	1638	P = 0.09; I² = 58%	RR (M-H, Fixed, 95% CI)	0.86 [0.27, 2.70]	P = 0.79
Incidence of new-onset CA (experienced)	1	163	Not applicable	RR (M-H, Fixed, 95% CI)	3.04 [0.13, 73.46]	P = 0.49
Incidence of new-onset CA (inexperienced)	6	2270	P = 0.14; I² = 43%	RR (M-H, Fixed, 95% CI)	1.42 [0.57, 3.56]	P = 0.45
24 h-mortality	6	1477	P = 0.82; I² = 0%	RR (M-H, Fixed, 95% CI)	1.29 [0.98, 1.69]	P = 0.07
24 h-mortality (RCT)	3	646	P = 1.00; I² = 0%	RR (M-H, Fixed, 95% CI)	3.06 [0.49, 19.25]	P = 0.23
24 h-mortality (non-RCT)	3	831	Not applicable	RR (M-H, Fixed, 95% CI)	1.23 [0.94, 1.62]	P = 0.13
24 h-mortality (CPR)	1	229	Not applicable	RR (M-H, Fixed, 95% CI)	1.23 [0.94, 1.62]	P = 0.13
24 h-mortality (non-CPR)	5	1248	P = 1.00; I² = 0%	RR (M-H, Fixed, 95% CI)	3.06 [0.49, 19.25]	P = 0.23
24 h-mortality (experienced)	1	164	Not applicable	RR (M-H, Fixed, 95% CI)	3.07 [0.13, 74.35]	P = 0.49
24 h-mortality (inexperienced)	5	1313	P = 0.73; I² = 0%	RR (M-H, Fixed, 95% CI)	1.27 [0.97, 1.67]	P = 0.08
28 d-mortality	7	1821	P = 0.98; I² = 0%	RR (M-H, Fixed, 95% CI)	1.04 [0.92, 1.19]	P = 0.52
28 d-mortality (RCT)	5	1382	P = 0.90; I² = 0%	RR (M-H, Fixed, 95% CI)	1.04 [0.86, 1.26]	P = 0.66
28 d-mortality (non-RCT)	2	439	P = 0.82; I² = 0%	RR (M-H, Fixed, 95% CI)	1.04 [0.88, 1.23]	P = 0.62
28 d-mortality (CPR)	1	229	Not applicable	RR (M-H, Fixed, 95% CI)	1.03 [0.86, 1.23]	P = 0.76
28 d-mortality (non-CPR)	6	1592	P = 0.95; I² = 0%	RR (M-H, Fixed, 95% CI)	1.05 [0.89, 1.24]	P = 0.57
28 d-mortality (experienced)	2	821	P = 0.94; I² = 0%	RR (M-H, Fixed, 95% CI)	1.22 [0.83, 1.79]	P = 0.32
28 d-mortality (inexperienced)	5	1000	P = 0.99; I² = 0%	RR (M-H, Fixed, 95% CI)	1.01 [0.88, 1.16]	P = 0.88

Abbreviations: EI Esophageal intubation, CA Cardiac arrest, RCT Randomized controlled trial, CPR Cardiopulmonary resuscitation, RR Risk ratio, M-H Mantel-Haenszel

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