Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation

Brian E. Driver, MD1; Matthew E. Prekker, MD1,2; Lauren R. Klein, MD1; et al

Key Points

Question

In patients admitted to the emergency department with difficult airway characteristics undergoing orotracheal intubation with a Macintosh laryngoscope blade, does a bougie facilitate higher first-attempt intubation success than an endotracheal tube + stylet?

Findings

In this randomized clinical trial that included 757 adults, bougie use resulted in significantly higher first-attempt intubation success than an endotracheal tube + stylet (96% vs 82%) for those with a difficult airway characteristic.

Meaning

Although bougie use led to a higher likelihood of first-attempt intubation success, further research is needed to assess generalizability to other institutions and settings.

DOI: 10.1001/jama.2018.6496