r/emergencymedicine • u/Radiant_Alchemist • 22d ago

Advice Will Video Laryngoscopy become the norm?

I love VL. They make standard laryngoscopes look brutal. They're less traumatizing, they give a better view, they have a better first-pass success. Sure you need to learn direct laryngoscopy but let's say in 5 years from now will they be used as routine in OR and ER intubations? Or will they be saved for hard cases?

I've been told that the equipment tends to suck and that we won't have VL as available as in the current department that I'm working so I should stick to Macintosh and McCoy.

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u/bellsie24 22d ago

I think it's a great tool that has an unbelievable amount of benefits for providers and patients.

I also think it has limitations that tend to get glazed over by some people championing "VL and bougie are the only option for great first pass success!!!!".

And I think some of these limitations are especially problematic in emergency medicine, namely how frequently the cameras can get obstructed by fluid or secretions, given our non-NPO patient population, difficulty in optimization, trauma, etc.

I also find the devices that require a completely different mechanical use/insertion (like the AirTraq) to be difficult as a backup/rescue device due to the fact you must use a different technique than you're already used to (and it's not as though we're anesthesia intubating half a dozen people a day with the ability to regularly rotate through devices to keep ourselves proficient).

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u/[deleted] 22d ago

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u/bellsie24 22d ago

I have nothing other than anecdotes with no data, but:

I'm unbelievably curious to see how the next decade plays out in terms of VL versus disposable fiberoptic scope intubations in the OR. A few of the anes/CC docs at my shop (who obviously do a lot of bronchs while on ICU coverage) are in love with fiber scopes and will do that before VL on any anticipated complicated airway.