Objective: To compare the video laryngoscope to the direct laryngoscope for tracheal intubation in emergency department patients. Methods: In total, 176 patients with respiratory failure, who were admitted for endotracheal intubation, were recruited in this prospective study. Patients in the experimental group received video laryngoscope for endotracheal intubation, while patients in the control group were treated with direct laryngoscope for endotracheal intubation (88 patients in each group). The one-time success rate, the insertion time, the success rate of cardiopulmonary resuscitation, and the degree of glottal exposure during endotracheal intubation in the two groups were compared. The heart rate, respiration, blood oxygen saturation, and systolic blood pressure in both groups at four time points, which were composed of before endotracheal intubation (T0), immediately after endotracheal intubation (T1), 30 min after endotracheal intubation (T2), and 1 h after endotracheal intubation (T3), were also compared. What's more, postoperative complications were compared between the two groups. Results: The insertion time in the experimental group was significantly shorter than that in the control group (P<0.05). The one-time success rate and effective glottal exposure rate in the experimental group were significantly increased when compared with the control group (P<0.05 and P<0.01, respectively). The heart rate, respiration, and systolic blood pressure at T1, T2, and T3 in the two groups after treatment were significantly lower than those before treatment, while blood oxygen saturation was significantly higher (all P<0.05). Compared with the control group, the systolic blood pressure at T1 in the experimental group was significantly declined (P<0.05). The total incidence of complications in the experimental group was significantly lower than that in the control group (6.82% vs. 18.18%, P<0.05). Conclusion: In emergency department, the application of video laryngoscope in patients with respiratory failure helps to shorten the intubation time, increase the one-time success rate, reduce the impact on hemodynamics, and decline the incidence of postoperative complications. It is worthy of clinical application.