Comparison of intubation performance by junior emergency department doctors using gum elastic bougie versus stylet reinforced endotracheal tube insertion techniques

Objective: Endotracheal intubation is a challenging procedure in emergency medicine. Junior doctors lack experience and confidence in this task. The use of a gum elastic bougie (GEB) to facilitate intubation may improve success rates, especially in difficult situations. Methods: Junior doctors working in the ED were studied. Endotracheal intubation was simulated using part-task trainers in "easy" positioning and "difficult" positioning modes. Intubation was attempted in both positions using either an endotracheal tube, with re-inforcing stylet (ETT-S), or insertion of a gum elastic bougie (GEB), with subsequent passage of the endotracheal tube over the bougie. Success rates and time to complete intubation were measured with GEB, and with ETT-S. Participants were asked to record the perceived ease of intubation. Results: One hundred and four intubations were performed by 26 study subjects. Overall, mean time to intubation with ETT-S technique was 16.14s (14.49-17.98 95% CI), and was faster than with GEB 24.18 (21.45-27.25 95% CI) in both airway difficulty grades (P < 0.01). The success rate for intubation using the GEB was 100%, compared with 92.9% with ETT-S. This difference was not statistically significant. Perceived ease of intubation was similar for GEB and ETT-S (VAS 6.808 vs 6.904). Conclusion: The use of a GEB marginally increases the time taken to perform endotracheal intubation. Success rates for junior doctors attempting endotracheal intubation were not significantly different between the two techniques. Success rates for novice practitioners using a GEB were high after even limited instruction and practice.