Difficulties with gum elastic bougie intubation in an academic emergency department

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] 71.188.0%). The GEB failure rate of the first laryngoscopist was 25/88 (28.4%; 95% CI 21.040.3%), with the two most common reasons being: inability to insert the bougie past the hypopharynx in 13 (52%; 95% CI 32.471.6%) and inability to pass the endotracheal tube over the bougie in six (24%; 95% CI 7.340.7). 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.