Video laryngoscopy versus direct laryngoscopy for pediatric emergency tracheal intubation: a systematic review and meta-analysis
7 affiliations
- 1Emergency Department, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
- 2Emergency Department, Queensland Children’s Hospital, Australia
- 3Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Brazil
- 4Heidelberg University, Medical Faculty Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
- 5University of the Free State, Bloemfontein, South Africa
- 6Department of Paediatrics, Western University, Canada Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- 7Division of Pediatric Critical Care Medicine, Stollery Children’s Hospital/University of Alberta, Edmonton, Canada
Abstract
Aim
To compare video laryngoscopy with direct laryngoscopy for pediatric intubation during cardiac arrest and peri-arrest scenarios.Methods
This systematic review (PROSPERO CRD420251081694) searched MEDLINE, Embase, and Cochrane from inception to May 1, 2026. Two authors independently screened studies; data were extracted by one and independently verified by a second reviewer. Eligible studies compared video versus direct laryngoscopy in pediatric acute care; emergency department, intensive care, and prehospital settings. Risk of bias was assessed using ROBINS-I and RoB2. Critical outcomes were survival to hospital discharge, first-pass intubation success, overall intubation success, and severe tracheal intubation-associated events. Additional data included study design, setting, age, operator type, and device. Meta-analyses used random-effects Mantel-Haenszel models reporting risk ratios (RR) with 95% confidence intervals. Certainty of evidence was assessed using GRADE.Results
Eighteen studies (17 observational, 1 RCT). First-pass success was higher with video laryngoscopy (72.2% vs 69.0%; RR 1.11, 95% CI 1.06-1.16; very low certainty). Severe adverse events were less frequent with video laryngoscopy (7.7% vs 11.8%; RR 0.76, 95% CI 0.62-0.93; very low certainty). Overall success (RR 1.00, 95% CI 0.99-1.01) and desaturation (RR 0.88, 95% CI 0.77-1.01) were similar. No studies reported survival outcomes or data specific to cardiac arrest.Conclusion
Among children undergoing emergency tracheal intubation, video laryngoscopy may be associated with improved first-pass success and fewer adverse events, although the certainty of evidence is very low and causal inferences are limited. No data were available for survival outcomes and cardiac arrest.
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BibTeX
@article{couto2026video,
title = {{Video laryngoscopy versus direct laryngoscopy for pediatric emergency tracheal intubation: a systematic review and meta-analysis}},
author = {Thomaz Bittencourt Couto and Jason Acworth and Leandra Rech and Stephan Katzenschlager and Michelle Myburgh and Barnaby R. Scholefield and Allan de Caen},
journal = {Resuscitation plus},
year = {2026},
month = oct,
doi = {10.1016/j.resplu.2026.101524},
url = {https://europepmc.org/article/PMC/PMC13717893},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Video laryngoscopy versus direct laryngoscopy for pediatric emergency tracheal intubation: a systematic review and meta-analysis
AU - Thomaz Bittencourt Couto
AU - Jason Acworth
AU - Leandra Rech
AU - Stephan Katzenschlager
AU - Michelle Myburgh
AU - Barnaby R. Scholefield
AU - Allan de Caen
PY - 2026
DA - 2026/10/07
JO - Resuscitation plus
DO - 10.1016/j.resplu.2026.101524
UR - https://europepmc.org/article/PMC/PMC13717893
AB - Aim To compare video laryngoscopy with direct laryngoscopy for pediatric intubation during cardiac arrest and peri-arrest scenarios.Methods This systematic review (PROSPERO CRD420251081694) searched MEDLINE, Embase, and Cochrane from inception to May 1, 2026. Two authors independently screened studies; data were extracted by one and independently verified by a second reviewer. Eligible studies compared video versus direct laryngoscopy in pediatric acute care; emergency department, intensive care, and prehospital settings. Risk of bias was assessed using ROBINS-I and RoB2. Critical outcomes were survival to hospital discharge, first-pass intubation success, overall intubation success, and severe tracheal intubation-associated events. Additional data included study design, setting, age, operator type, and device. Meta-analyses used random-effects Mantel-Haenszel models reporting risk ratios (RR) with 95% confidence intervals. Certainty of evidence was assessed using GRADE.Results Eighteen studies (17 observational, 1 RCT). First-pass success was higher with video laryngoscopy (72.2% vs 69.0%; RR 1.11, 95% CI 1.06-1.16; very low certainty). Severe adverse events were less frequent with video laryngoscopy (7.7% vs 11.8%; RR 0.76, 95% CI 0.62-0.93; very low certainty). Overall success (RR 1.00, 95% CI 0.99-1.01) and desaturation (RR 0.88, 95% CI 0.77-1.01) were similar. No studies reported survival outcomes or data specific to cardiac arrest.Conclusion Among children undergoing emergency tracheal intubation, video laryngoscopy may be associated with improved first-pass success and fewer adverse events, although the certainty of evidence is very low and causal inferences are limited. No data were available for survival outcomes and cardiac arrest.
SN - 2666-5204
ER -