Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway

Abstract

Objective: To compare the success and ease of bougie-assisted intubation (BAI) with those of traditional endotracheal intubation (ETI) in a simulated difficult airway (20.4 seconds for BAI vs. 16.7 seconds for ETI, p = 0.102).

Methods: This was a prospective, randomized, crossover, single-blind study comparing BAI with ETI in a simulated difficult airway. The 35 participants included paramedics, flight nurses, and emergency medicine resident physicians. Participants were already experienced in ETI and received a brief demonstration of BAI. A simulated difficult airway was created using a Laerdal adult intubation manikin. Cervical motion was mechanically limited to provide a grade III Cormack and Lehane glottic view. Participants performed ETI and BAI in randomized order. Successful placement in the trachea and time to successful placement were recorded for both techniques by each participant. After intubating the manikin with both techniques, each participant was asked to complete a Likert-style survey assessing ease of each technique.

Results: Of the 35 participants, 27 were successful with both techniques and two failed with both techniques. The remaining six participants all failed at ETI but were able to intubate using BAI. There was significantly greater success in intubating the simulated difficult airway with BAI than with ETI (94% vs. 77%, p = 0.0313). The order of techniques attempted did not influence this conclusion. There was no difference in average time to successful intubation (20.4 seconds for BAI vs. 16.7 seconds for ETI, p = 0.102). Thirty-two (91.4%) of the participants completed the survey regarding ease of performing each technique. Forty-one percent rated the ease of intubation as the same for the two methods, 50% rated BAI as easier, and 9% rated ETI as easier (p = 0.0006).

Conclusion: In a simulated difficult airway, BAI has a higher success rate than traditional ETI without increasing the time to successful intubation. Intubators perceive BAI as being easier to perform than traditional ETI in this simulated difficult airway scenario.