Comparison of direct laryngoscopy and digital intubation with and without bougie assistance in novice learners: A simulation-based study

Abstract

Background: Endotracheal (ET) intubation is a common emergency procedure generally done with direct laryngoscopy (DL). Digital intubation (DI), which uses blind finger guidance to manipulate the ET tube, is rarely used but is useful if secretions block the view or a laryngoscope is not available. DI can also be done bougie-assisted. This study aimed to compare three different approaches to intubation in simulation.

Methods: Medical students without prior airway training were invited to participate in this simulation study on an airway manikin. Participants viewed brief instructional videos on three different methods-DL, DI, and bougie-assisted DI-and performed three attempts with each method in a randomized order. Data were collected for the rate of successful intubations, the timing to intubation, and dental trauma.

Results: Fifty-one medical students performed 459 attempts at intubation on a manikin. On the third attempt, the trachea was successfully intubated in 65% of the attempts using DL, 53% with DI, and 90% with bougie-assisted DI. At the last attempt, the time to intubation was 35 (±16) s for DL, 28 (±10) s with DI, and 44 (±30) s with bougie-guided DI. Dental trauma was less frequent with DI.

Conclusion: Ninety percent of medical students successfully intubated a manikin on the third attempt when using a bougie to guide DI. A bougie-guided DI could be more likely to result in successful ET intubation than DL for those without sufficient training.

Keywords: airway and ventilation management; education and simulation; emergency medical services.