• Brian Driver, Kenneth Dodd, Lauren R Klein, Ryan Buckley, Aaron Robinson, John W McGill, Robert F Reardon, and Matthew E Prekker.
• Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: briandriver@gmail.com.
• Ann Emerg Med. 2017 Oct 1; 70 (4): 473-478.e1.

Study ObjectiveThe bougie may improve first-pass intubation success in operating room patients. We seek to determine whether bougie use is associated with emergency department (ED) first-pass intubation success.MethodsWe studied consecutive adult ED intubations at an urban, academic medical center during 2013. Intubation events were identified by motion-activated video recording. We determined the association between bougie use and first-pass intubation success, adjusting for neuromuscular blockade, video laryngoscopy, abnormal airway anatomy, and whether the patient was placed in the sniffing position or the head was lifted off the bed during intubation.ResultsIntubation with a Macintosh blade was attempted in 543 cases; a bougie was used on the majority of initial attempts (80%; n=435). First-pass success was greater with than without bougie use (95% versus 86%; absolute difference 9% [95% confidence interval {CI} 2% to 16%]). The median first-attempt duration was higher with than without bougie (40 versus 27 seconds; difference 14 seconds [95% CI 11 to 16 seconds]). Bougie use was independently associated with greater first-pass success (adjusted odds ratio 2.83 [95% CI 1.35 to 5.92]).ConclusionBougie was associated with increased first-pass intubation success. Bougie use may be helpful in ED intubation.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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