{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:47:51Z","timestamp":1782496071357,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t Heidelberg der Universit\u00e4t Heidelberg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Pulmonary aspiration during airway management is associated with increased morbidity and mortality. First-pass success during tracheal intubation is a key determinant of patient safety and has been shown to improve with videolaryngoscopy (VL). However, comparative evidence regarding hyperangulated VL and direct laryngoscopy (DL) during massive airway contamination remains limited, particularly within a standardized Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) workflow. This study aimed to compare DL and hyperangulated VL in a standardized SALAD simulation model. In this 1:1 randomized controlled simulation study, physicians performed tracheal intubation using a standardized regurgitation model. Participants were randomized to hyperangulated VL or DL. The primary endpoint was first-pass success (FPS). Secondary endpoints included time to successful tracheal intubation and time to first successful ventilation. Two hundred physicians from various specialties were enrolled and randomized. FPS was significantly higher in the VL group than in the DL group (94.0% vs. 58.0%; OR 11.34, 95% CI 4.54\u201328.35;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Time to successful tracheal intubation was significantly shorter in the VL group (median [IQR]: 34\u00a0s [29\u201340] vs. 41\u00a0s [35\u201348];\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Likewise, time to first ventilation was significantly reduced (median [IQR]: 40\u00a0s [34\u201344] vs. 45\u00a0s [40\u201353];\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). In multivariable logistic regression analysis, VL remained independently associated with FPS (adjusted OR 13.42, 95% CI 5.18\u201334.78;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), whereas age, sex, professional experience, specialty, and additional qualifications were not significantly associated with the primary outcome.\u00a0In this simulation model of massive airway contamination, hyperangulated videolaryngoscopy significantly improved first-pass success and reduced both intubation and ventilation times compared with direct laryngoscopy during SALAD-assisted airway management. Whether these procedural advantages translate into improved patient-centered outcomes requires confirmation in future clinical studies.\u00a0Trial Registration The registration of the clinical trial was initiated prospectively on July 15, 2024, in the German Clinical Trials Register (DRKS00034683).\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-60056-1","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:36:33Z","timestamp":1782491793000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct- versus video laryngoscopy during suction assisted laryngoscopy and airway decontamination (SALAD): A randomized controlled simulation study"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0559-8684","authenticated-orcid":false,"given":"Davut Deniz","family":"Uzun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Waidner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin P","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan C.","family":"Havel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gruebl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar R","family":"Zivkovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus A.","family":"Weigand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix C.F.","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Mohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"1","key":"60056_CR1","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/j.1399-6576.1986.tb02373.x","volume":"30","author":"GL Olsson","year":"1986","unstructured":"Olsson, G. L., Hallen, B. & Hambraeus-Jonzon, K. Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Acta Anaesthesiol. Scand. 30 (1), 84\u201392 (1986).","journal-title":"Acta Anaesthesiol. Scand."},{"issue":"5","key":"60056_CR2","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1093\/bja\/aer058","volume":"106","author":"TM Cook","year":"2011","unstructured":"Cook, T. M., Woodall, N. & Frerk, C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br. J. Anaesth. 106 (5), 617\u2013631 (2011).","journal-title":"Br. J. Anaesth."},{"issue":"4","key":"60056_CR3","first-page":"171","volume":"14","author":"M Robinson","year":"2013","unstructured":"Robinson, M. & Davidson, A. Aspiration under anaesthesia: risk assessment and decision-making. Continuing Educ. Anaesth. Crit. Care Pain. 14 (4), 171\u2013175 (2013).","journal-title":"Continuing Educ. Anaesth. Crit. Care Pain"},{"issue":"2","key":"60056_CR4","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/ALN.0000000000003831","volume":"135","author":"MA Warner","year":"2021","unstructured":"Warner, M. A. et al. Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis. Anesthesiology 135 (2), 284\u2013291 (2021).","journal-title":"Anesthesiology"},{"issue":"2","key":"60056_CR5","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1213\/01.ANE.0000122825.04923.15","volume":"99","author":"TC Mort","year":"2004","unstructured":"Mort, T. C. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth. Analg. 99 (2), 607\u2013613 (2004). table of contents.","journal-title":"Anesth. Analg"},{"issue":"12","key":"60056_CR6","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1111\/anae.15817","volume":"77","author":"N Chrimes","year":"2022","unstructured":"Chrimes, N. et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia 77 (12), 1395\u20131415 (2022).","journal-title":"Anaesthesia"},{"key":"60056_CR7","doi-asserted-by":"crossref","unstructured":"Root, C. W. et al. Suction Assisted Laryngoscopy and Airway Decontamination (SALAD): A technique for improved emergency airway management. Resusc Plus 1\u20132 :100005. (2020).","DOI":"10.1016\/j.resplu.2020.100005"},{"issue":"3","key":"60056_CR8","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jemermed.2014.04.021","volume":"47","author":"JB Gaither","year":"2014","unstructured":"Gaither, J. B. et al. Prevalence of difficult airway predictors in cases of failed prehospital endotracheal intubation. J. Emerg. Med. 47 (3), 294\u2013300 (2014).","journal-title":"J. Emerg. Med."},{"issue":"1","key":"60056_CR9","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/acem.12055","volume":"20","author":"JC Sakles","year":"2013","unstructured":"Sakles, J. C., Chiu, S., Mosier, J., Walker, C. & Stolz, U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad. Emerg. Med. 20 (1), 71\u201378 (2013).","journal-title":"Acad. Emerg. Med."},{"issue":"5","key":"60056_CR10","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1213\/ANE.0000000000000891","volume":"121","author":"M Bernhard","year":"2015","unstructured":"Bernhard, M., Becker, T. K., Gries, A., Knapp, J. & Wenzel, V. The First Shot Is Often the Best Shot: First-Pass Intubation Success in Emergency Airway Management. Anesth. Analg. 121 (5), 1389\u20131393 (2015).","journal-title":"Anesth. Analg"},{"issue":"6","key":"60056_CR11","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1097\/CCM.0000000000000213","volume":"42","author":"ME Prekker","year":"2014","unstructured":"Prekker, M. E. et al. The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation. Crit. Care Med. 42 (6), 1372\u20131378 (2014).","journal-title":"Crit. Care Med."},{"issue":"7","key":"60056_CR12","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1080\/10903127.2024.2360688","volume":"28","author":"CP Guillote","year":"2024","unstructured":"Guillote, C. P. et al. Prehospital SALAD Airway Technique in an Adolescent with Penetrating Trauma Case Report. Prehosp Emerg. Care. 28 (7), 965\u2013969 (2024).","journal-title":"Prehosp Emerg. Care"},{"issue":"3","key":"60056_CR13","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.redar.2023.08.002","volume":"71","author":"M G\u00f3mez-R\u00edos","year":"2024","unstructured":"G\u00f3mez-R\u00edos, M. et al. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. Rev. Esp. Anestesiol Reanim (Engl Ed). 71 (3), 171\u2013206 (2024).","journal-title":"Rev. Esp. Anestesiol Reanim (Engl Ed)"},{"issue":"3","key":"60056_CR14","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.redar.2023.08.001","volume":"71","author":"M G\u00f3mez-R\u00edos","year":"2024","unstructured":"G\u00f3mez-R\u00edos, M. et al. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. Rev. Esp. Anestesiol Reanim (Engl Ed). 71 (3), 207\u2013247 (2024).","journal-title":"Rev. Esp. Anestesiol Reanim (Engl Ed)"},{"key":"60056_CR15","doi-asserted-by":"publisher","first-page":"e081123","DOI":"10.1136\/bmj-2024-081123","volume":"389","author":"S Hopewell","year":"2025","unstructured":"Hopewell, S. et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. Bmj 389, e081123 (2025).","journal-title":"Bmj"},{"key":"60056_CR16","doi-asserted-by":"crossref","unstructured":"Kriege, M. et al. A comparison of the McGrath videolaryngoscope with direct laryngoscopy for rapid sequence intubation in the operating theatre: a multicentre randomised controlled trial. Anaesthesia (2024).","DOI":"10.1111\/anae.16250"},{"issue":"6","key":"60056_CR17","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1111\/anae.15985","volume":"78","author":"M Kriege","year":"2023","unstructured":"Kriege, M. et al. A multicentre randomised controlled trial of the McGrath\u2122 Mac videolaryngoscope versus conventional laryngoscopy. Anaesthesia 78 (6), 722\u2013729 (2023).","journal-title":"Anaesthesia"},{"issue":"6","key":"60056_CR18","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/s00101-024-01414-4","volume":"73","author":"T Piepho","year":"2024","unstructured":"Piepho, T. et al. [Recommendations of the new S1 guidelines on airway management]. Anaesthesiologie 73 (6), 379\u2013384 (2024).","journal-title":"Anaesthesiologie"},{"issue":"9","key":"60056_CR19","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1111\/anae.16326","volume":"79","author":"V K\u00f6hl","year":"2024","unstructured":"K\u00f6hl, V. et al. Hyperangulated vs. Macintosh videolaryngoscopy in adults with anticipated difficult airway management: a randomised controlled trial. Anaesthesia 79 (9), 957\u2013966 (2024).","journal-title":"Anaesthesia"},{"issue":"15","key":"60056_CR20","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1001\/jama.2024.0762","volume":"331","author":"K Ruetzler","year":"2024","unstructured":"Ruetzler, K. et al. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. Jama 331 (15), 1279\u20131286 (2024).","journal-title":"Jama"},{"issue":"12","key":"60056_CR21","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1097\/EJA.0000000000000525","volume":"33","author":"S Sulser","year":"2016","unstructured":"Sulser, S. et al. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: A randomised clinical trial. Eur. J. Anaesthesiol. 33 (12), 943\u2013948 (2016).","journal-title":"Eur. J. Anaesthesiol."},{"issue":"5","key":"60056_CR22","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1111\/acem.13160","volume":"24","author":"JC Sakles","year":"2017","unstructured":"Sakles, J. C. et al. The Impact of a Soiled Airway on Intubation Success in the Emergency Department When Using the GlideScope or the Direct Laryngoscope. Acad. Emerg. Med. 24 (5), 628\u2013636 (2017).","journal-title":"Acad. Emerg. Med."},{"issue":"6","key":"60056_CR23","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.jemermed.2011.06.007","volume":"42","author":"JM Mosier","year":"2012","unstructured":"Mosier, J. M., Stolz, U., Chiu, S. & Sakles, J. C. Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J. Emerg. Med. 42 (6), 629\u2013634 (2012).","journal-title":"J. Emerg. Med."},{"issue":"8","key":"60056_CR24","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1197\/j.aem.2006.02.016","volume":"13","author":"X Combes","year":"2006","unstructured":"Combes, X. et al. Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad. Emerg. Med. 13 (8), 828\u2013834 (2006).","journal-title":"Acad. Emerg. Med."},{"key":"60056_CR25","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s40814-019-0433-6","volume":"5","author":"A Loughnan","year":"2019","unstructured":"Loughnan, A., Deng, C., Dominick, F., Pencheva, L. & Campbell, D. A single-centre, randomised controlled feasibility pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients. Pilot Feasibility Stud. 5, 50 (2019).","journal-title":"Pilot Feasibility Stud."},{"issue":"20","key":"60056_CR26","doi-asserted-by":"publisher","first-page":"7430","DOI":"10.3390\/jcm14207430","volume":"14","author":"S Shaikh","year":"2025","unstructured":"Shaikh, S. et al. Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) for Emergency Airway Management: A Systematic Review of Evidence and Implementation. J. Clin. Med. 14 (20), 7430 (2025).","journal-title":"J. Clin. Med."},{"key":"60056_CR27","doi-asserted-by":"crossref","unstructured":"G\u00f3mez-R\u00edos, M., Michalek, P., Gaszy\u0144ski, T. & Van Zundert, A. A. J. Human Factors in Airway Management: Designing Systems for Safer, Team-Based Care. J Clin. Med 14(24). (2025).","DOI":"10.3390\/jcm14248850"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60056-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60056-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60056-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:53:36Z","timestamp":1782492816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60056-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,26]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["60056"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-60056-1","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,26]]},"assertion":[{"value":"26 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The protocol for this study was reviewed and endorsed by the ethics committee of the Medical Faculty of the University of Heidelberg, Germany (Registration No. S-184\/2024). The study was subsequently registered in the German Clinical Trials Register (DRKS00034683). Informed consent was obtained from all participants before the start of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"19629"}}