Paramedic use of the endotracheal tube introducer in a difficult airway model

To determine whether advanced life support (ALS)-level prehospital providers can be taught to effectively use the Flex-Guide (FG) Endotracheal Tube (ETT) introducer in a difficult airway model by comparing success of styleted ETT intubation with Flex-Guide-assisted intubation.

Intermediate and advanced providers, who brought patients to a Level 1 emergency department, were given a handout and viewed an instructional video describing the bougie and its use. A difficult airway was simulated using the CPR 5000 model mannequin from Medical Plastics Laboratory, Inc. The tongue was inflated to a pressure of 180 mm Hg to partially obscure the view of the airway and a cervical collar was placed to limit flexion and extension. Participants were then asked to intubate the mannequin using both the ETT with a stylet and the bougie-assisted method. Whether the providers used the FG or stylet method first was randomized. Success or failure was recorded and the McNemar test was used to evaluate the paired nonparametric data.

A total of 96 providers (66% advanced, 34% intermediate) were enrolled, 69 successfully intubated using the FG, while 64 successfully intubated with the stylet. Comparing successful bougie intubations with successful stylet intubations using the McNemar test, no significant difference was found between the groups (p = 0.486).

Prehospital care providers were as successful intubating a difficult airway model using the newly learned bougie technique as they were using the more familiar styleted ETT technique.