Will Video Laryngoscopy become the norm?

[u/Radiant_Alchemist]

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.

[u/OysterShocker → u/[deleted]]

They are the standard now for most intubations in North America. Most ER and anesthesia residents, for example, will be better at VL than DL.

[u/IntensiveCareCub → u/OysterShocker]

Anesthesia resident here: this is very program dependent. 90% of my intubations are DL. I only use VL for anticipated difficult airways and out of OR intubations (simply because that’s what’s more readily available).

[u/PerrinAyybara → u/IntensiveCareCub]

Typical anesthesia isn't comparable to the ED or Prehospital world. All of our airways are expected to be difficult and/or crash airways by the nature of the reasons we intubate.

[u/IntensiveCareCub → u/PerrinAyybara]

Difficult airways and physiologically challenging intubations are very different things. You can have patients with easy airways who are physiologically challenging, and vice versa. Just because someone requires optimization prior to intubation, that doesn't make them "difficult." Anesthesia does all the STAT airways for the hospital here and we do DL sometimes, just depends on what's available for equipment. It's perfectly safe in properly trained hands.

There are very few intubations where you can't spend even a few minutes optimizing the patient (impending airway closure, uncontrollable UGI/airway hemorrhage, to name a few)... improving their BP, pre-oxygenating, better positioning, etc. go a long way in making your intubation safer. It's good to have VL available nearby if needed and while data does show that VL has higher first past success, this difference diminishes with more experienced intubators.

I think the last point is the bigger caveat here. The experience in the emergency medicine world is significantly less than that of anesthesia both in intubating and managing the hemodynamics (especially in EMS where maybe paramedics rarely intubate, and I say this as someone who was a paramedic prior to medical school). That's not to say ED docs / paramedics aren't good at intubating - like anything else though it's a skill, and the more you do the better you get.

Point being, I don't think the rationale for ED/EMS using VL is because the airways are more difficult, but rather that the higher first past success rate is more applicable in less experienced personnel.