Should we be reaching for hyperangulated or standard geometry VL blades? Much to my dismay, a systematic review with meta-analysis of 25 studies and 39k patients published this month found that hyperangulated blades had 4% lower first-pass success with higher risk of airway trauma. However, a few things worth noting before the HAVLs are taken behind the barn... -The majority of the RCTs (n=16) were in the OR, not the ED or ICU -Most of the RCTs were relatively small (<200 patients total) so they placed relatively low weight into the pooled outcome -Unclear what to make of the signal of potentially higher risk of injury without a large RCT in the mixed ED/ICU population -The large number of observational data included are obviously confounded by unmeasured effect modifiers (remember... no level of statistical slicing and dicing will ever provide the balance that an RCT will) So, I do not think it's time to throw our hyperangulated blades in the trash, but thus far, the data does not support them being the amazing tool we initially thought they would be. doi.org/10.1016/j.ajem.2025.… PMID: 40939241 #emergency #emergencymedicine #criticalcare #icu #science #data #research #army #armymedicine #armyemdoc #airway #medx #medtwitter

In this systematic review from last month, Von Hellmann et al found that opioid pre-treatment had an odds ratio of 2.15 (1.22-3.78) for peri-intubation hypotension. doi.org/10.1097/mej.00000000… #emergency #emergencymedicine #criticalcare #icu #science #data #research #army #armymedicine #armyemdoc #airway #ketamine #medx #medtwitter