Intubation using the gum-elastic bougie while wearing personal protective equipment.
American Journal of Disaster Medicine · 2020-01-01 · Randomised trial
Abstract
OBJECTIVE: To determine whether application of a gum-elastic bougie (GEB), a visual stylet used to improve success rates of difficult intubations, reduces the time, and number of attempts to achieve successful intubation while wearing personal protective equipment (PPE). DESIGN: A randomized cross-over study comparing orotracheal intubations performed on an AirMan® Mannequin, using either a semirigid stylet or a GEB, while wearing an active hood with a charcoal impregnated suit and butyl rubber gloves. SETTING: Simulation training field of the Israel Defense Force Medical Corps. PARTICIPANTS: 27 military physicians and 23 paramedics (PMs). INTERVENTIONS: Comparing intubation with and without using the GEB while wearing PPE. MAIN OUTCOME MEASURE(S): Airway (AW) control was considered successful if the "lungs" of the mannequin ex-panded during bag ventilation. Three unsuccessful attempts or a procedure exceeding 60 seconds were regarded as a failure. Correlations between parameters of self-assessment of skills and successful intubation were also determined. RESULTS: With the GEB, success rate was lower (82 percent versus 100 percent, p = 0.002), more attempts were needed (1.4 ± 0.7 versus 1.0 ± 0.2, p = 0.005) and time-to-achieve AW control was longer (43.6 ± 14.6 sec-onds versus 23.1 ± 10.5 seconds, P < 0.001) than without it. Participants with high self-assessment of GEB-assisted AW management skills needed less attempts to perform successful intubation with GEB than participants with low self-assessment (1.0 ± 0.0 versus 1.4 ± 0.8, p = 0.001), but not less time to achieve it. CONCLUSIONS: While donning PPE, the use of GEB (versus semirigid stylets) did not reduce the time or the number of attempts necessary to achieve successful intubation.
Tags
Paramedics & EMTs · Military & tactical · Endotracheal intubation