DirEct Versus VIdeo LaryngosCopE Trial (DEVICE)
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT05239195 |
Recruitment Status :
Completed
First Posted : February 14, 2022
Last Update Posted : December 29, 2022
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Clinicians perform rapid sequence induction, laryngoscopy, and tracheal intubation for more than 5 million critically ill adults as a part of clinical care each year in the United States. Failure to intubate the trachea on the first attempt occurs in more than 10% of all tracheal intubation procedures performed in the emergency department (ED) and intensive care unit (ICU). Improving clinicians rate of intubation on the first attempt could reduce the risk of serious procedural complications.
In current clinical practice, two classes of laryngoscopes are commonly used to help clinicians view the larynx while intubating the trachea: a video laryngoscope (equipped with a camera and a video screen) and a direct laryngoscope (not equipped with a camera or video screen). For nearly all laryngoscopy and intubation procedures performed in current clinical practice, clinicians use either a video or a direct laryngoscope. Prior research has shown that use of a video laryngoscope improves the operator's view of the larynx compared to a direct laryngoscope. Whether use of a video laryngoscope increases the likelihood of successful intubation on the first attempt remains uncertain. A better understanding of the comparative effectiveness of these two common, standard-of-care approaches to laryngoscopy and intubation could improve the care clinicians deliver and patient outcomes.
Condition or disease | Intervention/treatment | Phase |
---|---|---|
Acute Respiratory Failure | Other: Video Laryngoscope Other: Direct Laryngoscope | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 1420 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | DirEct Versus VIdeo LaryngosCopE Trial |
Actual Study Start Date : | March 19, 2022 |
Actual Primary Completion Date : | November 17, 2022 |
Actual Study Completion Date : | December 16, 2022 |
Arm | Intervention/treatment |
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Active Comparator: Video Laryngoscope Group
For patients assigned to the video laryngoscope group, the operator will use a video laryngoscope on the first laryngoscopy attempt. A video laryngoscope will be defined as a laryngoscope with a camera and a video screen. Trial protocol will not dictate the brand of video laryngoscope.
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Other: Video Laryngoscope
Laryngoscope with a camera and a video screen |
Active Comparator: Direct Laryngoscope Group
For patients assigned to the direct laryngoscope group, the operator will use a direct laryngoscope on the first laryngoscopy attempt. A direct laryngoscope will be defined as a laryngoscope without a camera or a video screen. Trial protocol will not dictate the brand of direct laryngoscope or the blade shape.
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Other: Direct Laryngoscope
Laryngoscope without a camera or a video screen |
- Number of intubations with successful intubation on the first attempt [ Time Frame: Duration of procedure (minutes) ]The primary outcome is defined as placement of an endotracheal tube in the trachea with a single insertion of a laryngoscope blade into the mouth and EITHER a single insertion of an endotracheal tube into the mouth OR a single insertion of a bougie into the mouth followed by a single insertion of an endotracheal tube over the bougie into the mouth.
- Severe complications of tracheal intubation [ Time Frame: from induction to 2 minutes following tracheal intubation ]
The secondary outcome is defined as one or more of the following occurring between induction and 2 minutes after successful intubation:
- Severe hypoxemia (lowest oxygen saturation measured by pulse oximetry < 80%);
- Severe hypotension (systolic blood pressure < 65 mm Hg or new or increased vasopressor administration);
- Cardiac arrest not resulting in death within 1 hour of intubation; or
- Cardiac arrest resulting in death within 1 hour of induction
- Duration of laryngoscopy and tracheal intubation [ Time Frame: Duration of procedure (minutes) ]The interval (in seconds) between the first insertion of a laryngoscope blade into the mouth and the final placement of an endotracheal tube or tracheostomy tube in the trachea.
- Number of laryngoscopy attempts [ Time Frame: Duration of procedure (minutes) ]
- Number of attempts to cannulate the trachea with a bougie or an endotracheal tube [ Time Frame: Duration of procedure (minutes) ]
- Successful intubation on the first attempt without a severe complication [ Time Frame: from induction to 2 minutes following tracheal intubation ]Composite of patients who meet the primary outcome (successful intubation on the first attempt) without meeting the secondary outcome (severe complications of tracheal intubation)
- Reason for failure to intubate on the first attempt [ Time Frame: Duration of procedure (minutes) ]
Reason for failure among those who did not meet the primary outcome (successful intubation on the first attempt):
- Inadequate view of the larynx
- Inability to intubate the trachea with an endotracheal tube
- Inability to cannulate the trachea with a bougie
- Attempt aborted due to change in patient condition (e.g., worsening hypoxemia, hypotension, bradycardia, vomiting, bleeding)
- Technical failure of the laryngoscope (e.g., battery, light source, camera, screen)
- Other
- Operator-reported aspiration [ Time Frame: from induction to 2 minutes following tracheal intubation ]
- Esophageal intubation [ Time Frame: from induction to 2 minutes following tracheal intubation ]
- Injury to the teeth [ Time Frame: from induction to 2 minutes following tracheal intubation ]
- ICU-free days in the first 28 days [ Time Frame: 28 days ]
- Ventilator free days in the first 28 days [ Time Frame: 28 days ]
- All-cause in-hospital mortality [ Time Frame: 28 days ]
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patient is located in a participating unit.
- Planned procedure is orotracheal intubation using a laryngoscope.
- Planned operator is a clinician expected to routinely perform tracheal intubation in the participating unit.
Exclusion Criteria:
- Patient is known to be less than 18 years old.
- Patient is known to be pregnant.
- Patient is known to be a prisoner.
- Immediate need for tracheal intubation precludes safe performance of study procedures.
- Operator has determined that use of a video laryngoscope or use of a direct laryngoscope is required or contraindicated for the optimal care of the patient.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05239195
United States, Alabama | |
UAB Hospital | |
Birmingham, Alabama, United States, 35233 | |
United States, Colorado | |
University of Colorado Denver | |
Aurora, Colorado, United States, 80045 | |
Denver Health Medical Center | |
Denver, Colorado, United States, 80204 | |
United States, Louisiana | |
Ochsner Medical Center | Ochsner Health System | |
New Orleans, Louisiana, United States, 70112 | |
United States, Massachusetts | |
Beth Israel Deaconess Medical Center | |
Boston, Massachusetts, United States, 02215 | |
United States, Minnesota | |
Hennepin County Medical Center | |
Minneapolis, Minnesota, United States, 55415 | |
United States, North Carolina | |
Duke University Medical Center | |
Durham, North Carolina, United States, 27710 | |
Wake Forest Baptist Medical Center | |
Winston-Salem, North Carolina, United States, 27157 | |
United States, Tennessee | |
Vanderbilt University Medical Center | |
Nashville, Tennessee, United States, 37232 | |
United States, Texas | |
Brooke Army Medical Center | |
Fort Sam Houston, Texas, United States, 78234 | |
Baylor Scott & White Health | |
Temple, Texas, United States, 76508 | |
United States, Washington | |
Harborview Medical Center | |
Seattle, Washington, United States, 98104 |
Principal Investigator: | Matthew W Semler, MD, MSc | Vanderbilt University Medical Center | |
Principal Investigator: | Adit A Ginde, MD, MPH | University of Colorado, Denver | |
Study Chair: | Matthew E Prekker, MD, MPH | Hennepin County Medical Center, Minneapolis | |
Study Chair: | Stacy A Trent, MD, MPH | Denver Health Medical Center | |
Study Chair: | Brian E Driver, MD | Hennepin County Medical Center, Minneapolis | |
Study Director: | Jonathan D Casey, MD, MSc | Vanderbilt University Medical Center |
Responsible Party: | Jonathan Casey, Assistant Professor, Vanderbilt University Medical Center |
ClinicalTrials.gov Identifier: | NCT05239195 |
Other Study ID Numbers: |
211272 |
First Posted: | February 14, 2022 Key Record Dates |
Last Update Posted: | December 29, 2022 |
Last Verified: | December 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | Following publication, individual patient data will be made available for sharing to researchers with 1) a signed data access agreement, 2) research testing a hypothesis, 3) a protocol that has been approved by an institutional review board, and 4) a proposal that has received approval from the principal investigator. |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) |
Time Frame: | Following publication. No end date |
Access Criteria: |
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Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Critical Illness Emergency Airway Management Tracheal intubation Video laryngoscope Direct laryngoscope |
Respiratory Insufficiency Respiration Disorders Respiratory Tract Diseases |