Lit Matters 1: Video Laryngoscopy vs. Direct Laryngoscopy

Video laryngoscopy improves glottic view and is associated with higher first-pass intubation success in emergency airway management. In ED and ICU intubations, the practical question is less whether VL looks better than direct laryngoscopy and more how that view translates into tube delivery on the first attempt.

Video vs Direct Laryngoscopy

• Better glottic visualization: Video laryngoscopy produced a Cormack-Lehane grade 1 view on first attempt far more often than direct laryngoscopy, 70% versus 48%, reinforcing its advantage at the laryngoscopy step.
• Higher first-pass success: Tracheal intubation succeeded on the first attempt more often with video laryngoscopy than with direct laryngoscopy, 83.2% versus 72.2%, even when the analysis separated view from tube passage.
• Two-step airway framing: The key physiologic and procedural split is laryngoscopy versus tracheal tube delivery; this analysis asks whether a better view actually converts into successful intubation, a distinction worth hearing in the episode.
• Difficult airway preference: Operators chose video laryngoscopy in 75.9% of cases with one or more predictors of difficult airway, reflecting how VL has become the default rescue-friendly approach in emergency practice.
• Training curve advantage: Video laryngoscopy is generally easier to learn and teach, with proficiency often reached after roughly 30 to 40 intubations versus 70 to 100 for direct laryngoscopy.
• Consistent first approach: The practical takeaway is to standardize your default blade strategy and use it every time unless a specific indication pushes you elsewhere. We get into that operator-level decision in the chapter.