Video laryngoscopes improve success rates and reduce dental compression compared with direct laryngoscopes in pediatric cardiac arrest simulations.

PURPOSE: High-quality cardiopulmonary resuscitation (CPR) is crucial for improving survival in cardiac arrest. Effective airway management can enhance outcomes but remains challenging due to anatomical and physiological factors in children. However, whether endotracheal intubation is superior to bag-valve-mask ventilation during CPR remains uncertain. Video laryngoscopes have emerged as an alternative to direct laryngoscopes, offering enhanced visualization; however, their efficacy for pediatric CPR remains unclear. This systematic review and meta-analysis aimed to compare the efficacy of video laryngoscopes and direct laryngoscopes during pediatric CPR in simulation-based studies. METHODS: A systematic search of PubMed, Embase, and The Cochrane Library was conducted up to February 2025. Only randomized controlled trials conducted in simulation settings comparing video and direct laryngoscopes in pediatric CPR were included. The primary outcomes were the first attempt success rate and the overall success rate. The secondary outcomes included intubation time, Cormack and Lehane grade as an indicator of glottic visualization, and dental compression. The risk of bias for the included studies was assessed using the Cochrane Risk of Bias tool. Two reviewers independently evaluated each domain, and disagreements were resolved by consensus. RESULTS: Thirteen simulation-based studies with 2080 intubation attempts in manikins were included. Direct laryngoscopes demonstrated a 35% lower relative first-attempt success rate (RR: 0.65, 95% CI: 0.59-0.71) and a 17% lower relative overall success rate (RR: 0.83, 95% CI: 0.80-0.88) compared with video laryngoscopes. Intubation time was 8.13 seconds longer with direct laryngoscopes (MD: 8.13 s, 95% CI: 4.82-11.44). Furthermore, direct laryngoscopes were associated with a 39% lower relative likelihood of Cormack and Lehane grade 1 view (RR: 0.61, 95% CI: 0.49-0.76), and 6.05 times higher relative risk of dental compression (RR: 6.05, 95% CI: 2.93-12.52) compared with video laryngoscopes. CONCLUSION: Video laryngoscopes significantly improve intubation success rates and reduce intubation time during simulation-based pediatric CPR. Future research should validate these findings in clinical settings and evaluate device-specific features to optimize outcomes.