Abstract
Background
The difficulties with gum elastic bougie (GEB) use in the emergency department (ED)
have never been studied prospectively.
Objectives
To determine the most common difficulties associated with endotracheal intubation
using a GEB in the ED.
Methods
We conducted a prospective, observational study of GEB practices in our two affiliated
urban EDs with a 3-year residency training program and an annual census of 150,000
patients. Laryngoscopists performing a GEB-assisted intubation completed a structured
data form after laryngoscopy, recording patient characteristics, grade of laryngeal
view (using the modified Cormack-Lehane classification), reason for GEB use, and problems
encountered. Data were analyzed using standard statistical methods and 95% confidence
intervals.
Results
A GEB was used for 88 patients. The overall success rate was 70/88 (79.6%; 95% confidence
interval [CI] 71.1–88.0%). The GEB failure rate of the first laryngoscopist was 25/88
(28.4%; 95% CI 21.0–40.3%), with the two most common reasons being: inability to insert
the bougie past the hypopharynx in 13 (52%; 95% CI 32.4–71.6%) and inability to pass
the endotracheal tube over the bougie in six (24%; 95% CI 7.3–40.7).
Conclusions
The GEB is a helpful rescue airway device, but emergency care providers should be
aware that failure rates are relatively high at a teaching institution.
Keywords
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Article info
Publication history
Published online: June 28, 2010
Accepted:
May 2,
2010
Received in revised form:
February 5,
2010
Received:
October 31,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
