Surreal illustration symbolizing the balance between direct and video laryngoscopy.

Video Laryngoscopy: Is the Screen Really Necessary for Successful Intubation?

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Avery Sinclair in Health & Wellness December 2025 • 5 min read.

"A new study reveals surprising insights into the effectiveness of video laryngoscopy, challenging traditional assumptions about the role of screen viewing during intubation."


In emergency medicine, securing a patient's airway quickly and effectively is paramount. Video laryngoscopy (VL) has become a staple in modern airway management, offering a potentially clearer view of the vocal cords compared to traditional direct laryngoscopy (DL). The use of VL has been growing in the field for years, and many physicians consider it essential for difficult intubations.

The core principle behind VL is straightforward: a video camera attached to the laryngoscope blade provides a real-time view on a screen, guiding the physician as they insert the endotracheal tube. Conventional wisdom suggests that this enhanced visualization improves the chances of successful intubation on the first attempt and reduces the risk of complications. However, a recent study has raised some intriguing questions about this assumption.

Researchers at Hennepin County Medical Center investigated whether screen viewing during VL actually makes a significant difference in first-attempt intubation success. The results of their study challenge the traditional dependence on the screen, suggesting that other factors may play a more critical role in successful airway management. This article dives into the details of this study and explores what these findings mean for medical professionals.

Does Viewing the Screen Really Improve Intubation Success?

Surreal illustration symbolizing the balance between direct and video laryngoscopy.

The study, published in The American Journal of Emergency Medicine, retrospectively analyzed 593 video recordings of intubations performed in an urban emergency department in 2013. The aim was simple: to compare first-attempt intubation success rates when using a standard geometry Macintosh VL, stratified by whether the screen was viewed or not. A team of trained investigators reviewed the videos, noting various factors, including intubation indication, airway anatomy, and any complications encountered.

Interestingly, the study revealed no significant difference in first-attempt intubation success rates between cases where the screen was viewed and those where it was not. Specifically, the success rate when viewing the screen was 94% (195/207), while the success rate without screen viewing was also 94% (284/301). This challenges the belief that visual assistance via the screen is a critical factor in determining the outcome of the procedure.

  • Study Design: Retrospective, observational study using video review.
  • Setting: Urban, Level I trauma center with approximately 100,000 annual ED visits.
  • Participants: Adult ED patients who underwent tracheal intubation during 2013 using a Macintosh video laryngoscope.
  • Primary Outcome: First intubation attempt success.
  • Key Finding: No significant difference in first-attempt success rates whether the screen was viewed or not.
These findings do not imply that video laryngoscopy is unnecessary, but rather highlight the importance of other aspects, such as the operator's skill and experience. The study suggests that physicians may be intuitively using the screen when facing more complex cases, thereby compensating for the added difficulty. When the screen was used in the original study attempt, the median first-attempt duration was actually longer (45 versus 33 seconds). The difference was median 12 seconds [95%CI 10-15 seconds]).

Practical Implications and Future Directions

While the study offers fascinating insights into the use of video laryngoscopy, it's important to acknowledge its limitations. The retrospective nature of the study means it's subject to potential biases, and the data comes from a single center, which may limit its generalizability. However, the findings underscore the need for continued research into best practices for airway management. Future studies should explore the optimal balance between direct and video laryngoscopy, taking into account operator skill, patient characteristics, and clinical context. Ultimately, the goal is to equip healthcare professionals with the knowledge and tools they need to provide the best possible care for patients in emergency situations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is the primary difference between video laryngoscopy (VL) and direct laryngoscopy (DL) in airway management?

The primary difference lies in the visualization method. Direct laryngoscopy (DL) involves directly viewing the vocal cords using a laryngoscope. Video laryngoscopy (VL) uses a video camera attached to the laryngoscope blade to provide a real-time view on a screen. VL aims to offer a potentially clearer view and is often preferred in difficult intubations, though the study challenges its necessity in some contexts.

2

What were the key findings of the study regarding screen viewing during video laryngoscopy for intubation success?

The study, published in The American Journal of Emergency Medicine, found no significant difference in first-attempt intubation success rates whether the screen was viewed or not during video laryngoscopy (VL). Specifically, the success rate when viewing the screen was 94%, and the success rate without screen viewing was also 94%. This challenges the traditional belief that screen viewing is a critical factor in determining intubation success.

3

Why is video laryngoscopy (VL) used in emergency medicine and what are its benefits?

Video laryngoscopy (VL) is used in emergency medicine to secure a patient's airway quickly and effectively, which is paramount in such situations. It offers a potentially clearer view of the vocal cords compared to traditional direct laryngoscopy (DL). The benefit is the enhanced visualization that is expected to improve the chances of successful intubation on the first attempt and reduce complications.

4

What factors, besides screen viewing, might influence the success of intubation when using video laryngoscopy (VL) and how were they addressed in the study?

The study suggests that factors such as the operator's skill and experience may play a more critical role in successful airway management than screen viewing. While the study did not explicitly measure operator skill, it did note that when the screen was used, the median first-attempt duration was longer. The study also considered factors like intubation indication and airway anatomy but focused on the impact of screen usage on first-attempt success rates using a standard geometry Macintosh video laryngoscope.

5

What are the limitations of the study, and what implications do these limitations have on the application of its findings in emergency medical practice, specifically with regards to video laryngoscopy (VL)?

The study has limitations, including its retrospective nature and the fact that it was conducted in a single center. These factors introduce potential biases and may limit the generalizability of the findings. However, the study underscores the need for continued research into best practices for airway management. The implications suggest that while video laryngoscopy (VL) remains valuable, clinicians should focus on a broader range of factors, including operator skill and patient characteristics, to optimize patient care during emergency intubation. Future studies should explore the optimal balance between direct and video laryngoscopy, taking into account these various aspects.

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