Comparative Ultrasound Assessment of Standard and Wire-Core Airway Bougie Introducers in a Cadaver Model

This study compared point-of-care ultrasound (POCUS) accuracy in identifying a standard bougie (SB) versus a wire-core bougie (WCB) placed in the trachea or esophagus of cadaveric models. Using a trans-tracheal approach at the suprasternal notch, we assessed whether the WCB improves POCUS identification.

In this double-blind, randomized crossover trial, 31 emergency medicine and general surgery residents and faculty evaluated bougie placement in a controlled cadaveric lab. Participants were blinded to bougie type and location and interpreted real-time POCUS images as tracheal, esophageal, or indeterminate. The primary outcome was identification accuracy; secondary outcomes included sensitivity, specificity, accuracy, likelihood ratios, and time to identification.

After excluding indeterminate responses, 112 matched pairs were analyzed. Identification accuracy was higher with the WCB (98%; 110/112) than the SB (89%; 100/112). Although this 9% difference was statistically significant (P=.006), it did not meet the predetermined 20% threshold for clinical significance. The WCB showed superior sensitivity (96%) and specificity (100%) compared with the SB (92% and 86%, respectively). Median time to identification was similar: 3.3 seconds (IQR 2.4-6.4s) for the SB and 3.4 seconds (IQR 2.6-5.0s) for the WCB (P=.16).

POCUS accurately detects placement of both bougie types in cadaveric models. Although the WCB demonstrated higher diagnostic accuracy, the difference was not clinically meaningful based on the a priori threshold. Participants rapidly identified both devices, supporting POCUS as a feasible adjunct for airway confirmation. Additional studies are needed to evaluate POCUS detection of bougie placement during live intubations.