Standard Gum Elastic Bougie Versus Flexible Tip Bougie: Evaluation of Airway Adjuncts for Intubation by Paramedics in Entrapped Manikins with Difficult Airway Access-A Randomised, Controlled Trial

Airway management in pre-hospital settings is often challenging and difficult to perform. This is particularly true during tracheal intubation of entrapped patients with difficult airway access. There are various airway adjuncts available in the current practice. Their aim is to facilitate tracheal intubation. One of the recently introduced devices is the flexible tip bougie. The aim of this study was to evaluate the flexible tip bougie for intubation in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. An intubation manikin with the cervical collar on was placed on and secured to the driver's seat of a passenger car. The car was then positioned on its left side. The first attempt success rate as well as the intubation and successful ventilation time were recorded. The ease of use by the operator and user-friendliness were also assessed. The standard gum elastic bougie required the shortest mean intubation to successful ventilation time, 38.4 s (±9.6) vs. 41.4 s (±6.8), = 0.46. The first attempt success rate was higher in the standard gum elastic bougie group, 92% vs. 88%, = 0.04. There were no failed intubations when the standard gum elastic bougie was used. The flexible tip bougie was found to be more difficult to use and less user-friendly, 7.6 (±1.5) vs. 5.8 (±2.9), = 0.02. The standard gum elastic bougie was superior in terms of the first attempt success and the time required for intubation and successful ventilation. Moreover, it was found to be easier to use and more user-friendly.