Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial

Komasawa, Nobuyasu; Cho, Takashi; Mihara, Ryosuke; Minami, Toshiaki

doi:10.1016/j.ajem.2015.09.016

Cited by 20 publications

(6 citation statements)

References 17 publications

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“…In a model study by Komasawa et al [14] no difference was found between ETI groups in intubation with a Macintosh blade with and without using GEB in terms of ETI success. However, ETI via GEB was statistically more successful when chest compression was applied to both groups' models.…”

Section: Discussionmentioning

confidence: 89%

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Birinci¹,

Özerol²,

Divriklioğlu³

et al. 2022

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Objective: Endotracheal intubation (ETI) in children requires good techniques and experience. Gum elastic bougie (GEB) is a practical, inexpensive, easy-to-use airway method in the adult airway. Through GEB, ETI is a method that can be learned after a short training. We evaluated the effectiveness of this method, which has not yet been validated in pediatric patients in prehospital pediatric airway applications. Materials and Methods:This study was designed as a study simulating the prehospital period with a mankin. Practitioners were asked to perform intubation by conventional intubation or GEB.Results: This study was conducted with 48 emergency medical technicians and paramedics. Four (8.3%) of the practitioners had experience using GEB. In terms of first-pass success, no difference was found between ETI via GEB and Macintosh blade conventional ETI [91.7% (44/48), 93.8% (45/48), respectively, p=1.000]. Use of GEB increased ETI time [28.6±6.0 sec vs. 17.1±4.0 sec, mean df: 11.3 sec (95% CI: 9.7-12.8), p<0.001]. While 87.6% of the practitioners evaluated the use of GEB as very easy and easy, 83.3% of the practitioners evaluated the traditional method as very easy and easy (p=0.914). Conclusion:GEB does not make any difference in pediatric airway management in terms of first-pass success. However, the use of GEB in terms of ETI durations increases the duration of ETI. Besides, the use of GEB is seen as a method that can be applied more efficiently, even in inexperienced groups.

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Section: Discussionmentioning

confidence: 89%

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Birinci¹,

Özerol²,

Divriklioğlu³

et al. 2022

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“…However, neither study involved any pediatric patients. Similarly, studies using simulated airways, 1 , 15 , 16 , 17 , 18 , 19 , 20 cadavers, 21 , 22 and patients undergoing elective surgeries 23 to compare the first‐pass success rates of bougie, stylet, and naked endotracheal tube have all used adult subjects.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 Research investigating the efficacy of stylets in first‐pass success in pediatric patients has been limited to 2 neonatal studies. 13 , 14 Likewise, studies using airway manikins, 1 , 15 , 16 , 17 , 18 , 19 , 20 cadavers, 21 , 22 and elective surgical patients 23 to compare the efficacy of bougie and stylet have used only adult subjects.…”

Section: Introductionmentioning

confidence: 99%

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

Gan

Shepherd

2022

JACEP Open

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Objectives To investigate whether the use of adjuncts such as stylet, railroaded bougie, and preloaded bougie increases first‐pass success rate and decreases time to successful intubation when intubating simulated infant airways using direct laryngoscopy. Methods A crossover study using experienced practitioners (who were required to carry out emergency pediatric intubations as part of their usual practice) was completed. Participants completed a random sequence of 4 intubations in simulated “easy” airways and 4 intubations in simulated “difficult” airways, using naked endotracheal tube, stylet, railroaded bougie, and preloaded bougie on standardized infant airway manikins. First‐pass success rates and times to successful intubations were measured. Results From June 1 to December 30, 2019, 109 participants performed a total of 872 intubation attempts. In the easy airway, both naked endotracheal tube (mean 96.3% [95% confidence interval 90.9%–99.0%]) and stylet (mean 98.2% [95% confidence interval 93.5%–99.8%]) had higher first‐pass success rates than railroaded bougie and preloaded bougie. In the difficult airway, stylet (mean 76.1% [95% confidence interval 67.0%–83.8%]) had the highest first‐pass success rate, followed by the naked endotracheal tube, and then both the railroaded bougie and preloaded bougie. Differences in first‐pass success rates were independent of the participants’ numbers of previous pediatric intubations. Conclusion Results of this simulation‐based study suggest that stylet should be used as the first attempt technique for infant intubations regardless of the presence or absence of predicted airway difficulty. This finding needs further validation using alternative models and in non‐simulation settings.

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“…Research carried out by Driver et al [19] has also shown that the use of a bougie compared with an endotracheal tube with a stylet resulted in a significantly higher first-attempt intubation success among patients undergoing emergency endotracheal intubation. Also, a study by Komasawa et al suggests that a gum-elastic bougie facilitates tracheal intubation during chest compressions performed by novice physicians in adult simulations [27]. Lastly, Sheu et al indicate that the use of a bougie stylet compared with a standard endotracheal stylet during endotracheal intubation of patients under emergency medical conditions was associated with higher efficacy of the first intubation attempt [28].…”

Section: Discussionmentioning

confidence: 99%

“…To facilitate intubation, as demonstrated in this case, videolaryngoscopes may be an alternative [34–36], or the intubator can use a bougie stylet for difficult intubation. The second parameter that may reduce the effectiveness of intubation may be the fact that intubation is performed during resuscitation procedures, where chest compressions are implemented in parallel: moving the patient may make it difficult to visualize the vocal structures [27, 37].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

Evrın

Smereka

Gorczyca

et al. 2019

Emergency Medicine International

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Introduction. Airway management is one of key elements of resuscitation. Endotracheal intubation is still considered the gold standard for airway management during resuscitation. Aim. The aim of the study was to compare success rates and intubation time of different endotracheal intubation methods during emergency intubation with difficult airways in the conditions of cardiopulmonary resuscitation in a standardized manikin model. Methods. The study was designed as a prospective, randomized, cross-over simulation study. It involved 46 paramedics with at least 5 years of experience in Emergency Medical Service. The participants performed endotracheal intubation under difficult airway conditions during continuous chest compression, implemented with the LUCAS3 chest compression system. Three methods of tracheal intubation were applied: (1) standard Macintosh laryngoscope without a bougie stylet; (2) standard laryngoscope and a standard bougie stylet; (3) standard laryngoscope and a new bougie stylet. Results. The overall intubation success rate was 100% in the standard bougie and new bougie groups and lower (86.9%) when no bougie stylet was used (P=0.028). The intubation success rate with the 1st attempt equalled 91.3% for the new bougie group, 73.9% for standard bougie, and only 23.9% in the no-bougie group. The median intubation time was shortest in the new bougie group, where it amounted to 29 s (interquartile range [IQR]: 25–38); the time equalled 38s (IQR:31–44.5) in the standard bougie group and 47.5s (IQR:36–58) in the no-bougie group. The ease of use was lowest in the no-bougie group (85, IQR:63–88), average in the standard bougie group (44, IQR:30–51), and highest in the new bougie stylet group (32, IQR:19–41). Conclusion. In this manikin-based study, paramedics were able to perform endotracheal intubation with higher efficacy and in a shorter time using the new bougie stylet as compared with the standard bougie stylet.

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Utility of gum-elastic bougie for tracheal intubation during chest compressions in a manikin: a randomized crossover trial

Cited by 20 publications

References 17 publications

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

The adjuncts for endotracheal tube passage in simulated pediatric airways (AET‐SPA) study

Comparison of Different Intubation Methods in Difficult Airways during Simulated Cardiopulmonary Resuscitation with Continuous Chest Compression: A Randomized Cross-Over Manikin Trial

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