Advancing emergency airway management: Video laryngoscope vs intubating laryngeal mask airway in critical care

Abstract

This editorial comments on the randomized controlled trial by Aggarwal et al, which demonstrates video laryngoscope (VL) superiority over intubating laryngeal mask airway (ILMA) for emergency intubation in critically ill patients-first-pass success (87.5% vs 53.1%), intubation times (44.0 ± 19.7 seconds vs 82.5 ± 14.5 seconds), and reduced complications including oral trauma (0% vs 26.9%) and sore throat (3.1% vs 26.9%). VL’s camera-enhanced visualization ensures precise navigation in high-stakes scenarios where patients have limited physiological reserve, positioning it as the frontline device per updated Difficult Airway Society guidelines. ILMA retains value as rescue ventilation during failed VL attempts despite its longer procedure times and tissue trauma risks, warranting availability in all emergency airway algorithms. These rigorous findings guide intensivists toward protocol revisions prioritizing VL training, resource allocation, and simulation drills-particularly in resource-limited intensive care units. Future multicenter trials should validate performance across difficult airways and evaluate cost-effectiveness to optimize implementation globally.

Keywords: Airway management; Critical care; Emergency intubation; Intubating laryngeal mask airway; Video laryngoscope; First-pass success; Resource-limited settings

Core Tip: This editorial highlights Aggarwal et al’s trial showing video laryngoscopy (VL) outperforming intubating laryngeal mask airway (ILMA) in critically ill patients, with higher first-attempt success (87.5% vs 53.1%), faster intubation (44.0 ± 19.7 seconds vs 82.5 ± 14.5 seconds), and fewer complications. Superior glottic visualization positions VL as first-line for emergency airways, with ILMA as rescue. Findings advocate protocol revisions, VL training, and resource prioritization for better outcomes.