Use of a bougie during emergency rapid sequence intubation (RSI) appears to increase first attempt success but may increase time to a definitive airway. This analysis was performed to explore primary use of a bougie during air medical RSI.
For this analysis, patients undergoing RSI by air medical crews were identified from a large air medical database. First attempt success (FAS), and first attempt success without desaturation (FASWD) were used as outcome measures. Patients in whom a bougie was used during the initial intubation attempt were compared to patients undergoing intubation without the bougie. Propensity scores for bougie use were calculated and multiple logistic regression used to calculate odds ratios for both outcome measures.
A total of 11,836 air medical RSI patients were identified. Patients in whom a bougie was used on the first attempt had more difficult airway predictors. Logistic regression analysis with propensity adjusted odds ratios revealed no associations between use of a bougie on first attempt and FAS (adjusted OR 0.92, 95% CI 0.80-1.05, p=0.212). However, FASWD rates were statistically significantly lower with use of a bougie on first attempt after adjusting for age, gender, trauma, and presence of difficult airway criteria (adjusted OR 0.85, 95% CI 0.75-0.96, p=0.009).
Primary use of the bougie during intubation resulted in similar rates of first pass success when compared to non-bougie group. Primary bougie use may be associated with a higher rate of desaturation during first attempt intubation. Limitations include the potential for selection bias not addressed by the statistical models. Further examination to explore the effects of bougie use related to desaturation is recommended.