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The following is a summary of “Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis” published in the February 2024  issue of Emergency Medicine by Hellmann, et al.

A bougie, a bendable endotracheal tube introducer, has been suggested as a way to improve the success rate of first-try intubations in the emergency room.

For a study, researchers sought to look at the information that was out there about the link between using a bougie on the first try and success in tracheal intubations. It was a systematic review and meta-analysis of studies that looked at first-attempt success rates for people who were intubated with a bougie versus those who were intubated without a bougie (usually with a stylet) in all situations. 

Studies with manikins or cadavers were not included. From the start of the project until June 2023, a medical reader looked through Ovid Cochrane Central, Ovid Embase, Ovid Medline, Scopus, and Web of Science for randomized controlled trials and compared observational studies. Two separate reviewers chose which studies to look at and extracted data twice. They used random-effects models to do a meta-analysis and GRADE to rate the strength of the evidence at the outcome level. Of the 2,699 studies They looked at, 133 were chosen for full-text review. Quantitative analysis was done on 18 works 12 randomized controlled trials. A review of 18 studies with 9,151 patients found that using a bougie was linked to a higher success rate for the first try at intubation (RR = 1.11, 95% CI = 1.06 to 1.17; low certainty evidence). 

Using a bougie was linked to a higher chance of success on the first try in all categories that were looked at, with similar effect estimates. This was true even for emergency intubations (9 studies; 8,070 patients; RR 1.11, 95% CI 1.05 to 1.16, low certainty). There was a high likelihood that a bougie would help patients with Cormack-Lehane III or IV (5 studies, 585 patients, RR 1.60, 95% CI 1.40 to 1.84, reasonable certainty). The meta-analysis found that using the bougie to help with the first try at inhalation was linked to better results. There wasn’t a lot of evidence to back this up, but these numbers show that a bougie should probably be used first and not as a saving device during emergency intubations.

Source: sciencedirect.com/science/article/abs/pii/S0196064423011411