Malleable stylet vs. re-useable and disposable bougies in a model of difficult intubation: a randomised cross-over trial.

Malcolm Woollard, David Lighton, P Gregory, Graham Munro, E Jenkinson, Leanne Hamilton, R.O. Newcombe, Peter O'Meara

Research output: Book chapter/Published conference paperConference paperpeer-review

Abstract

Introduction: Paramedics' intubation success rates with Cormack and Lehane grade III/IV1 views have been reported as 0%.2Misplaced tracheal tubes occur in 5.8'25%3,4 of all intubations:67'75% may be in the oesophagus.4,5 This trial compared intubationoutcomes for pre-hospital laryngoscopists managing a model of agrade III/IV Cormack and Lehane view with three different trachealtube introducers (bougies) and a malleable stylet.Methods: Pre-hospital laryngoscopists attending the AustralianCollege of Ambulance Professionals (ACAP) conference (September2007) attempted to intubate a manikin model of a Cormack andLehane grade III/IV view using each of four intubation aids in accordancewith a prospectively randomised sequence (one attempt perdevice). A successful intubation was defined as correct placementwithin 30 s.Results: 19/65 (29%) of the participants claimed previous experiencewith a bougie and 46/65 (71%) with a stylet. Intubation successrates were 37/65 (57%) with the stylet and with the bougies 22/65(34%, Portex single-use), 17/65 (26%, Fova) and 6/65 (9%, Portexre-usable), p < 0.0001.There was no correlation between intubationsuccess and prior experience. Oesophageal intubation rateswere 19/65 (29%, stylet); 29/65 (45%, Portex single-use); 21/65(32%, Fova); and 27/65 (42%, Portex re-usable), p = 0.026. Mediantimes to intubation (with ranges) were 20 s (6'60 s, stylet); 30 s(15'60 s, Portex single-use); 42 s (12'60 s, Fova); and 49 s (16'60 s,Portex re-usable), p < 0.001. Median difficulty-of-use scores (with100 representing 'very difficult') were 30, 28, 40, and 80 for thestylet, Portex single-use, Fova, and Portex re-usable, respectively,p < 0.001.Posters S41Conclusions: In pre-hospital laryngoscopists attending the ACAP2007 conference, a malleable stylet facilitated the highest intubationsuccess rate within the shortest interval in a manikin model of a grade III/IV view. There were significant betweendevicedifferences in oesophageal intubation rates and user-rateddifficulty-of-use scores.
Original languageEnglish
Title of host publicationResuscitation 2009
Subtitle of host publicationNinth Congress
Place of PublicationUnited Kingdom
PublisherEuropean Resuscitation Council
PagesS40-S41
Publication statusPublished - 2009
EventCongress of the European Resuscitation Council - Cologne, Germany, Germany
Duration: 02 Oct 200903 Oct 2009

Conference

ConferenceCongress of the European Resuscitation Council
Country/TerritoryGermany
Period02/10/0903/10/09

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