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Multicenter Study
. 2021 Jan:158:215-219.
doi: 10.1016/j.resuscitation.2020.11.003. Epub 2020 Nov 9.

Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial

Austin J Bonnette  1 , Tom P Aufderheide  2 , Jeffrey L Jarvis  3 , Jason A Lesnick  1 , Graham Nichol  4 , Jestin N Carlson  5 , Matthew Hansen  6 , Shannon W Stephens  7 , M Riccardo Colella  2 , Henry E Wang  8
Affiliations
Multicenter Study

Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial

Austin J Bonnette et al. Resuscitation. 2021 Jan.

Abstract

Objective: Paramedics may perform endotracheal intubation (ETI) while treating patients with out-of-hospital cardiac arrest (OHCA). The gum elastic Bougie (Bougie) is an intubation adjunct that may optimize intubation success. There are few reports of Bougie-assisted intubation in OHCA nor its association with outcomes. We compared intubation success rates and OHCA outcomes between Bougie-assisted and non-Bougie ETI in the out-of-hospital Pragmatic Airway Resuscitation Trial (PART).

Methods: This was a secondary analysis of patients receiving ETI enrolled in the Pragmatic Airway Resuscitation Trial (PART), a multicenter clinical trial comparing intubation-first vs. laryngeal tube-first strategies of airway management in adult OHCA. The primary exposure was use of Bougie for ETI-assistance. The primary endpoint was first-pass ETI success. Secondary endpoints included overall ETI success, time to successful ETI, return of spontaneous circulation, 72-h survival, hospital survival and hospital survival with favorable neurologic status (Modified Rankin Score ≤3). We analyzed the data using Generalized Estimating Equations and Cox Regression, adjusting for known confounders.

Results: Of the 3004 patients enrolled in PART, 1227 received ETI, including 440 (35.9%) Bougie-assisted and 787 (64.1%) non-Bougie ETIs. First-pass ETI success did not differ between Bougie-assisted and non-Bougie ETI (53.1% vs. 42.8%; adjusted OR 1.12, 95% CI: 0.97-1.39). ETI overall success was slightly higher in the Bougie-assisted group (56.2% vs. 49.1%; adjusted OR 1.19, 95% CI: 1.01-1.32). Time to endotracheal tube placement or abandonment was longer for Bougie-assisted than non-Bougie ETI (median 13 vs. 11 min; adjusted HR 0.63, 95% CI: 0.45-0.90). While survival to hospital discharge was lower for Bougie-assisted than non-Bougie ETI (3.6% vs. 7.5%; adjusted OR 0.94, 95% CI: 0.92-0.96), there were no differences in ROSC, 72-h survival or hospital survival or hospital survival with favorable neurologic status.

Conclusion: While exhibiting slightly higher ETI overall success rates, Bougie-assisted ETI entailed longer airway placement times and potentially lower survival. The role of the Bougie assistance in ETI of OHCA remains unclear.

Keywords: Airway management; Cardiopulmonary arrest; Emergency medical service; Intubation.

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Figures

Figure 1 –
Figure 1 –
Overview of study population.
Figure 2 –
Figure 2 –
Time to intubation for Bougie vs non-Bougie endotracheal intubation. Median time to intubation was 13 minutes for Bougie use and 11 minutes for non-Bougie use (adjusted hazard ratio 0.63, 95% CI: 0.95 to 1.00)
See this image and copyright information in PMC

References

    1. Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Annals of emergency medicine. 2012;60:749–754 e742. - PubMed
    1. Wang HE, Mann NC, Mears G, Jacobson K, Yealy DM. Out-of-hospital airway management in the United States. Resuscitation. 2011;82:378–385. - PubMed
    1. Nwanne T, Jarvis J, Barton D, Donnelly JP, Wang HE. Advanced airway management success rates in a national cohort of emergency medical services agencies. Resuscitation. 2020;146:43–49. - PubMed
    1. Wang HE, Kupas DF, Paris PM, Bates RR, Costantino JP, Yealy DM. Multivariate predictors of failed prehospital endotracheal intubation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2003;10:717–724. - PubMed
    1. Wang HE, Kupas DF, Paris PM, Bates RR, Yealy DM. Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation. Resuscitation. 2003;58:49–58. - PubMed

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