Video versus Macintosh laryngoscopes for prehospital tracheal intubation in Japan: a propensity score matching analysis

Objective In recent years, the efficacy of tracheal intubation for out-of-hospital cardiac arrest (OHCA) performed by emergency medical technicians has been a subject of considerable debate. This study aimed to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (cerebral performance categories 1-2 [CPC1-2]), and regional differences between the use of video laryngoscopes (VLs) and Macintosh laryngoscopes (MLs) in OHCA patients. Methods This retrospective cohort study utilized data from 10,067 OHCAs and emergency medical transports, extracted from national Utstein-style data and compared using propensity score matching. The primary endpoints were the success rate of tracheal intubation and the complication rate. Results In this study, 885 intubated OHCA patients were enrolled, and 664 were analyzed after propensity score matching. The success rate was significantly higher in the VL group (94.0%; 312/332) than in the ML group (89.8%; 298/332) (relative risk, 1.05; 95% confidence interval, 1.00–1.10; P=0.040). Esophageal intubation occurred in 0% (0/332) of the VL group and in 5.7% (19/332) of the ML group, reflecting a statistically significant difference (relative risk, 1.06; 95% confidence interval, 1.03–1.09; P<0.001). The ROSC and CPC1-2 rates were similar in both groups. Conclusion Our data suggest that VLs offer a slight advantage with a higher success rate and lower complication rate. Further discussion is warranted regarding the preferential use of VLs and the development of emergency medical services intubation devices.