Dissertations & Theses (Open Access)

Date of Award

Summer 8-2017

Degree Name

Doctor of Philosophy in Nursing (PhD)


Deanna Grimes, DrPH - Chair

Second Advisor

Sandra K. Hanneman, PhD

Third Advisor

David R. Lairson, PhD

Fourth Advisor

Michael Gonzales M.D.


Purpose: Rapid intubation is essential for the critically ill patient in the emergency department in order to ensure adequate oxygenation. Regardless of presenting illness or injury, the first pass success rate (FPSR) can impact patient morbidity and mortality. The study aim was to evaluate the FPSR of direct laryngoscopy (DL) compared with video laryngoscopy (VL) in adult patients intubated in the emergency department.

Methods: Ovid Medline, Cochrane Library database, Embase, and Google Scholar were searched for peer-reviewed articles of studies of human subjects reporting a comparison of FPSR between VL and DL in adult patients who were orotracheally intubated in the emergency department. A meta-analysis was conducted using odds ratio (OR) as the summary effect measure for FPSR. A pooled effect size with the 95% Confidence Interval (CI) was calculated using a random effect model with inverse weighted method.

Results: 8,428 intubations (5,840 DL and 2,588 VL) from nine studies (five observational and four randomized controlled trials) were included in the sample. The pooled OR for FPSR across all studies was 1.89 [95% CI = 1.17, 3.07; p < 0.01], favoring VL when compared with DL. The results were limited by potential bias (selection and performance) and high levels of heterogeneity [I2 = 88%; 95% CI: 79%, 93%; Q = 64.61; p < 0.01].

Conclusions: Threats to validity made it difficult to conclude with certainty that one device is better than the other for achieving a successful intubation on the first attempt in the emergency department.


emergency, intubation, video laryngoscopy, meta-analysis

Included in

Nursing Commons



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