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Updated: Jun 11, 2026

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Difficulties with gum elastic bougie intubation in an academic emergency department
Kaushal H Shah1, Brian Kwong, Alberto Hazan
1Columbia University College of Physicians and Surgeons, New York, New York, USA.
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.
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