Video laryngoscopy versus direct laryngoscopy in a UK pre-hospital physician/critical care paramedic helicopter emergency medical service

Background It is recognised that multiple attempts at intubation are associated with harm. However, it remains unclear whether video laryngoscopy (VL) significantly improves pre-hospital tracheal intubation success compared to direct laryngoscopy (DL) in critically ill patients. While operating theatre studies strongly favour VL, some pre-hospital studies suggest it may worsen outcomes. Methods This single-centre retrospective service evaluation included critically ill patients requiring pre-hospital tracheal intubation by a UK-based Helicopter Emergency Medical Service (HEMS) Hampshire & Isle of Wight Air Ambulance between 1st November 2018 and 22nd April 2024. This time period saw the introduction of VL with the option to use it versus DL. Patient demographics, intubation indication, anaesthetic drugs, and intubation technique (type of laryngoscopy, grade of view, number of attempts, and complications) were collated. The primary outcome was first-pass success, comparing VL and DL groups, with significance set at p = < 0.05. Results We included 1,279 patients (median age 56, 69% male), of whom 478 (37%) received VL and 803 (63%) received DL. The most common indication for intubation was low GCS (n = 477 (39%). Overall, First-pass success was 92% (n = 443) in the VL group and 84% (n = 799) in the DL group. Since the introduction of VL in June 2022, both the proportion of VL intubations and first-pass success rates have increased annually. Conclusion Our findings support the routine use of VL for pre-hospital tracheal intubation.