• Andrew J Latimer, Brenna Harrington, Catherine R Counts, Katelyn Ruark, Charles Maynard, Taketo Watase, and Michael R Sayre.
• Department of Emergency Medicine, University of Washington, Seattle, WA; Seattle Fire Department, Seattle, WA. Electronic address: alatim@uw.edu.
• Ann Emerg Med. 2021 Mar 1; 77 (3): 296-304.

Study ObjectiveThe bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie.MethodsA prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt. We included all patients with a paramedic-performed intubation attempt. Logistic regression was used to examine the association between routine bougie use and first-attempt success rate.ResultsParamedics attempted intubation in 823 patients during the control period and 771 during the bougie period. The first-attempt success rate increased from 70% to 77% (difference 7.0% [95% confidence interval 3% to 11%]). Higher first-attempt success rate was observed during the bougie period across Cormack-Lehane grades, with rates of 91%, 60%, 27%, and 6% for Cormack-Lehane grade 1, 2, 3, and 4 views, respectively, during the control period and 96%, 85%, 50%, and 14%, respectively, during the bougie period. Intubation during the bougie period was independently associated with higher first-attempt success rate (adjusted odds ratio 2.82 [95% confidence interval 1.96 to 4.01]).ConclusionRoutine out-of-hospital use of the bougie during direct laryngoscopy was associated with increased first-attempt intubation success rate.Copyright © 2020. Published by Elsevier Inc.

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