What is the role of video laryngoscopy in pre-hospital care?

Background Direct laryngoscopy is the primary method for performing tracheal intubation in the pre-hospital setting. Failure to quickly establish an airway can result in hypoxemia, aspiration, neurologic damage, cardiovascular complications, and death. In-hospital data derived form 50,760 apparently normal patients undergoing surgery suggest that difficult laryngoscopy occurs in 5.8% [1]. When intubation is required in a pre-hospital scenario, the incidence of difficult laryngoscopy is doubled even when experienced anaesthesiologists are involved, and expected to reach some 20% when less qualified operators are in charge [2]. Thus, failed intubation rates in the emergency medical service may be as high as 7% [3].