Une bougie dans la sonde: c'est mieux.

Comparison of Intubation Performance by Emergency Medicine Residents Using Gum Elastic Bougie versus Standard Stylet in Simulated Easy and Difficult Intubation Scenarios

Walsh RM et All. Emerg Med Australas - ; 26 (5); 446-9 

Study Objectives: 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 single study 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 (Grade 1 ETT-S, Grade 1 GEB, Grade 3 ETT-S, Grade 3 GEB). The primary end-point of our investigation was the time to intubation. Secondary endpoints 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. To assess the effect of intubation type (GEB vs ETT-S) and difficulty on time to successful intubation and perceived ease of intubation, repeated measures ANOVAs were conducted. To examine whether success of intubation differed across the GEB and ETT-S groups we used a McNemar’s test. To examine the effect of previous experience on time to intubation, we used a mixed model ANOVA incorporating intubation type and difficulty of intubation.

Results: Mean time to intubation in all scenarios ranged from 28.8 – 116.6 seconds. Year of residency training trended toward significance but was not significant when comparing post-graduate year to time to intubation (p¼ 0.07). Time to intubation was significantly different only when comparing Grade 3 ETTS to Grade 3 GEB (p¼ 0.006). Of the 116 intubations performed in this study, a total of 36 were failed attempts. There was no significant difference in success rate when comparing Grade 1 ETT-S to Grade 1 GEB nor Grade 3 ETT-S to Grade 3 GEB (p ¼ >0.05). Across all year groups, participants perceived the Grade 1 scenario to be easier than the Grade 3 scenario. At the conclusions of the study, 55% of participants preferred using the GEB in all settings. When broken down by scenario, 41% preferred the GEB in the Grade 1 scenario while 76% preferred the GEB in the Grade 3 scenario.

Conclusions: 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. This is important because in the emergency department when difficult airways can be high stress and life threatening, although the GEB group took more time, the success rates were higher.