Protocol and Statistical Analysis Plan for the Hyperangulated versus Standard Geometry Laryngoscope Blade (ANGLE) Trial

Background: Emergency tracheal intubation is common and high risk. Although guidelines recommend using a video laryngoscope to intubate critically ill adults, whether a hyperangulated or standard-geometry blade is more likely to achieve successful intubation on the first attempt remains unknown. Research Question: Does the use of a video laryngoscope with a hyperangulated blade increase the incidence of successful intubation on the first attempt among adults undergoing emergency tracheal intubation, compared to use of a video laryngoscope with a standard-geometry blade? Study Design and Methods: The HyperANgulated versus Standard Geometry Laryngoscope BladE (ANGLE) trial is a pragmatic, multicenter, unblinded, parallel-group, randomized trial being conducted in 28 sites (10 emergency departments and 18 intensive care units) in the United States. The trial compares use of a video laryngoscope with a hyperangulated blade versus a standard-geometry blade among 2,500 critically ill adults undergoing emergency tracheal intubation. The primary outcome is successful intubation on the first attempt. The secondary outcome is the incidence of hypoxemia during intubation. Enrollment began on December 30, 2025, and is expected to conclude in 2027. Interpretation: The ANGLE trial will provide important data on the effects of the use of a video laryngoscope with a hyperangulated blade versus standard-geometry blade on successful intubation on the first attempt and other outcomes of emergency tracheal intubation. Specifying the protocol and statistical analysis plan before the conclusion of enrollment increases the rigor, reproducibility, and transparency of the trial. Trial Registry: ClinicalTrials.gov; No.: NCT07223762 ; URL: www.clinicaltrials.gov