Abstract
BackgroundThis unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the “Flexible Tip Bougie” (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%. Participants were Emergency Medicine and Anaesthesia trainees with recent experience of less than twenty patient intubations. The primary outcome was time to intubation, further divided into time taken to pass the ETI and time to railroad the endotracheal tube (ETT) over the ETI. The secondary outcome was the difficulty of intubation.ResultsThe median total time to ETT placement was significantly shorter with the FTB (37.5 s) compared with the FROVA ETI (63.0 s), P = 0.0006. The median difficulty reported (scores 0–10 with 0 being no difficulty) with the FTB was 2 compared with 5 for the FROVA, P < 0.0001.ConclusionsThe FTB enabled significantly faster and easier placement of the endotracheal tube compared with the FROVA in inexperienced hands intubating a difficult intubation manikin.
Highlights
Intubation is challenging for the novice intubator in the emergency department where suboptimal positioning, urgency and injuries can add to the difficulty
Characteristics of study subjects Emergency Medicine trainees were in year one to four and Anaesthetic residents were in their second year of residency, rotating through an anaesthesia term
Main results The median total time to endotracheal tube placement was significantly shorter with the Flexible Tip Bougie” (FTB) (37.5 s) compared with the FROVA endotracheal tube introducers (ETIs) (63.0 s), P = 0.0006
Summary
Devices to assist GlideScope intubation include stylets and endotracheal tube introducers (ETIs) (bougies), and the latter have been used to improve intubation success when difficulty is encountered [5] These static guides can be bent into a curve which cannot be altered during each intubation attempt. A previous difficult airway manikin study has compared these two devices with experienced intubators and found that the FTB was superior with reduced time to intubation and easier intubation [7] This unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the “Flexible Tip Bougie” (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%.
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