Comparison of intubating laryngeal mask airway and video laryngoscope during emergency intubation in patients who are critically ill

BACKGROUND Emergency endotracheal intubation is a high-risk procedure in patients who are critically ill and associated with complications such as hypoxia, hemodynamic instability, and airway trauma. The intubating laryngeal mask airway (ILMA) and video laryngoscope (VL) are alternative devices to conventional direct laryngoscopy, but their comparative efficacy in emergency settings remains understudied. AIM To compare the first-attempt success rate, intubation time, hemodynamic response, and complications between ILMA and VL in emergency intubations. METHODS A prospective randomized study was conducted on 64 patients who were critically ill and requiring emergency intubation. Patients were divided into the VL (n = 32) and ILMA (n = 32) groups. Primary outcomes included first-attempt success rate and intubation time. Secondary outcomes assessed hemodynamic changes (mean arterial pressure, heart rate, oxygen saturation) and complications (trauma, desaturation, sore throat). RESULTS The VL group had a significantly higher first-attempt success rate (87.5% vs 53.1%, P = 0.009) and shorter total intubation time (44.0 ± 19.7 seconds vs 82.5 ± 14.5 seconds, P < 0.001). Hemodynamic responses were comparable, but ILMA was associated with more complications (mouth damage: 26.9% vs 0%, P = 0.002; sore throat: 26.9% vs 3.1%, P = 0.009). CONCLUSION VL is superior to ILMA for emergency intubation, offering higher first-pass success, faster intubation, and fewer complications. VL should be prioritized in critical care settings.