Video laryngoscopes to help intubation in people with difficult airways

The technologies described in this briefing are 11 video laryngoscopes. They are used to help the placement of breathing tubes in people with difficult airways.

The innovative aspects are that the devices use an integrated camera and video display monitor to provide an indirect view of the airway.

The intended use would be in people of any age who need tracheal intubation, but there are anticipated difficulties in visualising the glottis. It could be used in emergency or secondary care settings.

The main points from the evidence summarised in this briefing are from 9 studies (4 systematic reviews with meta-analyses and 5 user survey studies). These include a total of 5,467 laryngoscopy procedures (in people with difficult airways, mainly adults) in the emergency and secondary care settings. They show that video laryngoscopy works at least as well as direct laryngoscopy to help intubation of adults with difficult airways and gives better visualisation of the glottis. One systematic review suggested that video laryngoscopy is associated with a higher severe complication rate in critically ill people in hospital. User surveys show that availability, routine use and positive attitudes towards video laryngoscopy have increased over time.

Key uncertainties around the evidence are a lack of evidence for use in children and babies and any published economic evidence.

The cost of video laryngoscopes range from £245 to £7,149 per unit for integrated display models and £7,589 to £13,003 per unit for cart-based models (exclusive of VAT). The resource impact would be greater than standard care because of the price differential between direct and video laryngoscopes. This may be offset by staff time savings from improved intubation success rates and fewer postponed procedures because of failed direct laryngoscopies.