Comparison of Video and Direct Laryngoscopy for Resident-Performed Tracheal Intubation at a Tertiary Care Hospital in Karachi

Abstract

Objectives: Tracheal intubation is a critical airway management skill frequently performed by resident physicians, yet the literature comparing video laryngoscopy and direct laryngoscopy in this trainee population remains limited. Previous studies highlight differences in success rates, complications, and visualization quality between both techniques, but their applicability to real-world resident training requires further exploration. We aimed to compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy for tracheal intubation performed by residents at a tertiary care cardiac hospital in Karachi. Methodology: This non-randomized comparative observational study enrolled 166 adult patients undergoing tracheal intubation from September 2023 to February 2024. Participants were assigned to either video laryngoscopy (Group-V) or direct laryngoscopy (Group-D) based on consecutive sampling. Efficacy was defined as first-attempt success, and safety was assessed by the absence of complications such as desaturation, aspiration, soft-tissue injury, bronchospasm, or esophageal intubation. Results: Each group comprised 83 patients. Group-V demonstrated a significantly higher first-attempt success rate (78.3%) than Group-D (59.0%) (p = 0.007) and required fewer attempts (1.24 ± 0.46 vs. 1.42 ± 0.52; p < 0.001). Complication-free intubation was also more frequent in Group-V (68.7%) compared to Group-D (53.0%) (p = 0.039). Conclusion: Video laryngoscopy was associated with superior efficacy and a more favorable safety profile compared with direct laryngoscopy in resident-performed intubations. These findings support the integration of video laryngoscopes into residency training programs to enhance airway management skills and reduce adverse events.