Vol 5, No 1 (2020)
Research paper
Published online: 2020-02-12

open access

Page views 709
Article views/downloads 650
Get Citation

Connect on Social Media

Connect on Social Media

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

Katarzyna Karczewska12, Jacek Smereka23, Marek Dabrowski4, Adam Lisiecki2, Dawid Golik5, Dominika Dunder2, Szymon Bialka6, Lukasz Szarpak52, Kurt Ruetzler7
Disaster Emerg Med J 2020;5(1):30-40.


INTRODUCTION: Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight SL tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression. 

MATERIAL AND METHODS: We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view. 

RESULTS: The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = –11.29 [–13.10, –9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for DL (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08). 

CONCLUSIONS: Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

Article available in PDF format

View PDF Download PDF file


  1. Bodily JB, Webb HR, Weiss SJ, et al. Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation. Ann Emerg Med. 2016; 67(3): 389–395.
  2. Ewy GA, Zuercher M, Hilwig RW, et al. Improved neurological outcome with continuous chest compressions compared with 30:2 compressions-to-ventilations cardiopulmonary resuscitation in a realistic swine model of out-of-hospital cardiac arrest. Circulation. 2007; 116(22): 2525–2530.
  3. Bai W, Golmirzaie K, Burke C, et al. Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department. Paediatr Anaesth. 2016; 26(4): 384–391.
  4. Sulser S, Ubmann D, Schlaepfer M, et al. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: A randomised clinical trial. Eur J Anaesthesiol. 2016; 33(12): 943–948.
  5. Markic S. Endotracheal tube ETView as a tool for airway management. Disaster and Emergency Medicine Journal. 2018; 3(4): 152–153.
  6. Moritz A, Schreiner W, Schmidt J. One-lung ventilation after rapid-sequence intubation: a novel approach using an ETView tracheoscopic ventilation tube for placement of an EZ-Blocker without bronchoscopy. J Clin Anesth. 2016; 29: 48–49.
  7. Karczewska K, Smereka J, Szarpak L, et al. Successful one-lung ventilation using the VivaSight-EB bronchial blocker tube for an emergency lung injury. A simulation pilot data. Disaster and Emergency Medicine Journal. 2019; 4(4): 131–136.
  8. Umutoglu T, Bakan M, Topuz U, et al. Comparison of EtView™ tracheoscopic ventilation tube and video-assisted fiberoptic bronchoscopy during percutaneous dilatational tracheostomy. J Clin Monit Comput. 2017; 31(3): 507–512.
  9. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009; 339: b2535.
  10. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
  11. Dabrowski M, Dabrowska A, Wieczorek W, et al. Is ETView SL better than a standard direct laryngoscopy for novice physicians in the simulated resuscitation? Resuscitation. 2017; 118: e43–e44.
  12. Gawlowski P, Smereka J, Madziala M, et al. Comparison of the ETView Single Lumen and Macintosh laryngoscopes for endotracheal intubation in an airway manikin with immobilized cervical spine by novice paramedics: A randomized crossover manikin trial. Medicine (Baltimore). 2017; 96(16): e5873.
  13. Karczewska K, Szarpak L, Smereka J, et al. ET-View compared to direct laryngoscopy in patients with immobilized cervical spine by unexperienced physicians: A randomized crossover manikin trial. Anaesthesiol Intensive Ther. 2017; 49(4): 274–282.
  14. Kurowski A, Szarpak L, Truszewski Z, et al. Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?: A Randomized Crossover Manikin Study. Medicine (Baltimore). 2015; 94(21): e850.
  15. Madziala A, Majer J, Madziała M. Comparison of ETView SL, Airtraq, and Macintosh laryngoscopes for face-to-face tracheal intubation: a randomized crossover manikin trial. Am J Emerg Med. 2016; 34(9): 1893–1894.
  16. Madziała M. The ETView tracheoscopic ventilation tube for trauma patient intubation. Disaster and Emergency Medicine Journal. 2018; 3(2): 69–70.
  17. Stawicka I, Czyzewski L, Smereka J, et al. Comparison of four laryngoscopes for orotracheal intubation by nurses during resuscitation with and without chest compressions: a randomized crossover manikin trial. Disaster and Emergency Medicine Journal. 2016; 1(1): 14–23.
  18. Szarpak Ł, Truszewski Z, Kurowski A, et al. Tracheal intubation with a VivaSight-SL endotracheal tube by paramedics in a cervical-immobilized manikin. Am J Emerg Med. 2016; 34(2): 309–310.
  19. Szarpak L, Smereka J, Ruetzler K. Abstracts of the Scientific Symposium on Emergency Medicine 2016, 28-29 October 2016. Hong Kong Journal of Emergency Medicine. 2017; 23(5): 307–317.
  20. Truszewski Z, Szarpak Ł, Smereka J, et al. Comparison of the VivaSight single lumen endotracheal tube and the Macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial. Am J Emerg Med. 2016; 34(5): 929–930.
  21. Truszewski Z, Krajewski P, Fudalej M, et al. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial. Medicine (Baltimore). 2016; 95(44): e5170.
  22. Park L, Zeng I, Brainard A. Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. Emerg Med Australas. 2017; 29(1): 40–47.
  23. Kerslake D, Oglesby AJ, Di Rollo N, et al. EDIR investigators. Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations. Resuscitation. 2015; 89: 20–24.
  24. Higgs A, McGrath BA, Goddard C, et al. Difficult Airway Society. DAS guidelines on the airway management of critically ill patients. Anaesthesia. 2018; 73(8): 1035–1036.
  25. Duggan LV, Ballantyne Scott B, Law JA, et al. Transtracheal jet ventilation in the 'can't intubate can't oxygenate' emergency: a systematic review. Br J Anaesth. 2016; 117(Suppl 1): i28–i38.
  26. Gerardi MJ, Sacchetti AD, Cantor RM, et al. Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians. Ann Emerg Med. 1996; 28(1): 55–74.
  27. Miller KA, Nagler J. Advances in Emergent Airway Management in Pediatrics. Emerg Med Clin North Am. 2019; 37(3): 473–491.
  28. Barak M, Putilov V, Meretyk S, et al. ETView tracheoscopic ventilation tube for surveillance after tube position in patients undergoing percutaneous nephrolithotomy. Br J Anaesth. 2010; 104(4): 501–504.

Disaster and Emergency Medicine Journal