Comparison of intubation performance by emergency medicine residents using gum elastic bougie versus standard stylet in simulated easy and difficult intubation scenarios.

OBJECTIVE

We sought to evaluate the success rate and time to endotracheal intubation by emergency medicine residents with stylet reinforced endotracheal tube (ETT-S) versus intubation with a gum elastic bougie (GEB) in simulated easy and difficult airways on a cadaveric model.

METHODS

The study was a prospective cross-over design using a cohort of 29 emergency medicine residents. A fresh frozen cadaver was used in either standard positioning to facilitate a Cormack Lehane Grade 1 laryngoscopy, or with a hard cervical collar applied a Cormack Lehane Grade 3 laryngoscopy. Each participant then intubated the cadaver in each setting. The primary end-point of our investigation was the time to intubation. Secondary end-points were: success rate of intubation, mean ratings by study participants of perceived ease of intubation for each intubation technique in each simulated degree of difficulty, and overall preference of intubation technique in each simulated degree of difficulty.

RESULTS

Mean time to intubation in all scenarios ranged from 28.8-116.6 s. Time to intubation was significantly different only when comparing Grade 3 ETT-S to Grade 3 GEB. There was no significant difference in success rate when comparing Grade 1 ETT-S to Grade 1 GEB (P = 0.99) nor Grade 3 ETT-S to Grade 3 GEB (P = 0.21).

CONCLUSION

Time to intubation in a simulated grade 3 view was significantly longer in the GEB group versus the ETT-S group. Although the differences in success rates were not statistically significant, there was a trend toward more successful intubations with the GEB in the simulated grade 3 view.