Don't blame it on the bougie

This prospective, randomized, crossover, single-blind study compared bougie-assisted intubation (BAI) with standard endotracheal intubation (ETI) in a simulated difficult airway.

Study participants were paramedics, physicians and nurses with variable experience of ETI who were attending an annual skills competency assessment.

Each participant performed ETI and BAI in a randomized order on a mannequin with a cervical collar in situ, simulating a Cormack and Lehane grade III laryngoscopic view.

Success was defined as intubation of the trachea prior to first ventilation, regardless of number of attempts. Of 35 participants, 27 were successful and 2 failed using both techniques. The remaining 6 failed with ETI but achieved success with BAI.

BAI was associated with a significantly higher success rate when compared with ETI (94% vs 77%, P=0.0313). There was no significant difference in average time to intubation (20.4 seconds BAI vs 16.7 seconds ETI, P=0.102).

Of the 35 participants who completed a post– study survey, 50% rated BAI as easier, 9% rated ETI as easier and 41% rated the ease of intubation the same for the two techniques.