What Is Video Laryngoscopy?
Video laryngoscopy (VL) uses a camera mounted on or near the blade tip to display the airway on a screen, providing an indirect view of the glottis without requiring direct line-of-sight alignment of the oral, pharyngeal, and laryngeal axes. This technology has significantly improved first-pass intubation success rates in both hospital and prehospital settings.
Advantages Over Direct Laryngoscopy
Video laryngoscopy offers several advantages for prehospital airway management:
- Improved glottic visualization: VL typically provides a better view of the vocal cords, especially in patients with difficult airway anatomy
- Higher first-pass success rates: Studies show VL improves first-attempt intubation success in the prehospital setting
- Reduced cervical spine manipulation: VL requires less head and neck positioning, making it advantageous for trauma patients with potential spinal injuries
- Teaching and supervision: The screen display allows partners, preceptors, and medical directors to observe the intubation attempt in real time
- Documentation: Many VL devices can record the intubation for quality review and training purposes
Common Video Laryngoscopes in EMS
Several video laryngoscope brands are used in prehospital care, including the GlideScope, King Vision, McGrath, and C-MAC. Each has different blade geometries and handling characteristics. Some use a hyperangulated blade that requires a stylet-guided technique, while others use a standard geometry blade that allows both direct and video-assisted views. Familiarize yourself with the specific device your agency carries and practice with it regularly.
Tips for Successful Video Laryngoscopy
Insert the blade in the midline, not sweeping the tongue to the left as with direct laryngoscopy. Look at the screen, not into the patient's mouth. Use a pre-shaped stylet with appropriate angulation for hyperangulated blades. Keep the camera lens clean; secretions, blood, and fogging can obscure the view. Have suction ready and accessible. Practice on mannequins to develop proficiency before field use.
Remember that video laryngoscopy is a tool, not a guarantee of success. Always have backup airway plans ready, including supraglottic airways and surgical airway equipment. The best airway device is the one you can use effectively to achieve ventilation and oxygenation for your patient.