How to review a Video Laryngoscopy

Review should begin with the procedural sequence rather than with a search for errors. The aim is first to understand what happened, then determine why it happened, and finally identify what could be repeated or improved.

Here is an example review schema which combines the stepwise approach to video laryngoscopy with the published SGVL and HAVL performance-error taxonomies. The same framework can be used for self-review, peer review, airway education and quality improvement.

1. Establish context

Separate information known from the clinical record or debrief from what is actually visible on the video.

Case ID	Indication	Attempt	Technique	Laryngoscope / blade	Tube adjunct
			☐ SGVL ☐ HAVL ☐ Other		☐ Bougie ☐ Stylet ☐ Other

Context is not observation. Preoxygenation, drug choice, physiology, team communication and events outside the camera view should be documented separately rather than inferred from the recording.

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2. Three-pass video review

Pass 1: Watch uninterrupted

Question: What happened overall? Watch the recording once without pausing or detailed error coding. Preserve the overall impression before frame-by-frame analysis.

Overall impression	Major difficulty	Rescue / corrective manoeuvre	Tube passage visible?	First-pass success
Example: Some difficulty	initial loss of orientation	blade withdrawn and re-centred	Yes	Yes
				0

Pass 2: Describe sequentially

Question: What actually happened at each stage? Use the same sequence as the stepwise approach page:

Blade entry → Orientation → Epiglottis → Blade-tip position → Glottic exposure → Device delivery → Tube passage

Stage	Time	What was observed?	Problem / deviation	Correction / recovery
Example	00:12	Epiglottis visible but blade advances beyond it	Orientation lost / overly deep	Blade withdrawn until epiglottis reappears
Blade entry
Orientation
Epiglottis
Blade-tip position
Glottic exposure
Device delivery
Tube passage

Pass 3: Classify

Question: Does what I observed meet a recognised performance-error definition?

Describe before you classify. When operator intent cannot be determined from the recording, record the observation and uncertainty rather than assigning an error with false confidence.

Time	Performance error	Recognised by operator?	Corrected?	Rescue / adaptation?
00:12	Overly deep insertion	Yes	Yes	No
		☐ Yes ☐ No ☐ Unclear	☐ Yes ☐ No ☐ N/A	☐ Yes ☐ No ☐ Unclear
		☐ Yes ☐ No ☐ Unclear	☐ Yes ☐ No ☐ N/A	☐ Yes ☐ No ☐ Unclear

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Outcome

Outcome	Record
First-pass success	☐ Yes ☐ No ☐ Unknown
Best glottic view
Tube passage through glottis visible	☐ Yes ☐ No ☐ Unclear
Attempt duration
Visible complication / trauma
Attempt abandoned / technique changed

Outcome and technical performance are not equivalent. A successful attempt may contain performance errors, while a technically appropriate attempt may fail because of anatomy, contamination or other factors.

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Feedback

1. Strength to reinforce
What should the operator deliberately repeat next time?

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2. Priority microskill
What single issue would produce the greatest improvement?

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3. Specific action
What should the operator actually do differently?

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Optional:

Secondary learning point: _____________________________________

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Summary

A video review should not become an inventory of every minor imperfection. Prioritise the observations most likely to improve subsequent performance. Where several errors arise from the same underlying problem such as loss of midline orientation, target feedback to the underlying microskill rather than simply list each downstream error.

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References