Videolaryngoscopy vs. direct laryngoscopy for tracheal intubation by anaesthesia resident doctors ( VILARE ): a pragmatic multicentre randomised trial

Summary Introduction Videolaryngoscopy has been associated with improved glottic visualisation and higher first‐attempt tracheal intubation success compared with direct laryngoscopy. However, multicentre evidence evaluating its effectiveness when tracheal intubation is performed by anaesthesia resident doctors in routine practice is limited. Methods Adult patients undergoing surgery requiring tracheal intubation were assigned to videolaryngoscopy or direct laryngoscopy for the initial attempt. All tracheal intubations were performed by anaesthesia residents under consultant supervision. The primary outcome was successful tracheal intubation on the first attempt. Secondary outcomes included glottic visualisation; number of tracheal intubation attempts; need for adjunct airway devices; procedural difficulty; and procedural complications. Results We enrolled 1001 patients and assigned 501 to videolaryngoscopy and 500 patients to direct laryngoscopy. Successful first‐attempt tracheal intubation was achieved in 397 (79.2%) patients allocated to the videolaryngoscopy group and 351 (70.2%) patients allocated to the direct laryngoscopy group (absolute risk difference 9.0%, 95%CI 3.7–14.4%, p < 0.001). Videolaryngoscopy improved glottic visualisation, with more patients having a modified Cormack–Lehane grade 2 or 2a view (467/501 (93.3%) vs. 404/500 (80.8%); p < 0.001); decreased operator‐reported tracheal intubation difficulty (168/501 (33.5%) vs. 236/500 (47.2%); p < 0.001) and reduced procedural complications (39/501 (7.7%) vs. 91/500 (18.2%); p < 0.001), without a clinically meaningful difference in tracheal intubation time or the need for adjunct airway devices. Discussion In adult patients undergoing tracheal intubation by anaesthesia resident doctors, videolaryngoscopy increased first‐attempt success and improved overall procedural performance compared with direct laryngoscopy.