Use of the Gum Elastic Bougie in the Difficult EMS Airway

[Ridryder 911]

FYI: Review http://www.merginet.com/index.cfm?pg=airway&fn=GEB

Use of the Gum Elastic Bougie in the Difficult Prehospital Airway

By Bryan E. Bledsoe, DO, FACEP

December 2005, MERGINET—The gum elastic bougie (GEB) is an excellent tool for intubating patients who have a difficult airway. The GEB is common in operating rooms and emergency departments—but less so on ambulances. French researchers studied the use of GEBs in the prehospital setting. (Remember, though, in France the ambulances are usually staffed by a physician.) The study assessed the effectiveness of the GEB in difficult airway intubation occurring in the prehospital setting. After mannequin training to GEB usage, prehospital physicians were recommended to use the GEB as first alternative technique in case of difficult intubation. The intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded for more than 30 months.

Among the 1,442 prehospital intubations performed, 41 patients (3 percent) required GEB. The GEB allowed successful intubation in 33 cases (78 percent) while 8 patients sustained a second alternative technique. One patient was never intubated. Another required an emergency cricothyroidotomy. Twenty-four (60 percent) of GEB patients had associated factors for difficult intubation such as reduced or limited cervical spine mobility; morbid obesity; cervicofacial trauma; or an ears, nose and throat tumors. The success rate of GEB was 75 and 94 percent, respectively, depending on whether associated factors for difficult intubation are present or not. No adverse events associated to GEB use were noted.

The GEB should be a part of every prehospital intubation kit. Also, the specialty courses (i.e., Street Level Airway Management [sLAM]) courses are excellent in terms of developing critical skills for the management of the difficult airway.

Reference

Jabre P. Combes X. Leroux B. et al. “Use of gum elastic bougie for prehospital difficult intubation.†The American Journal of Emergency Medicine. 2005:23(4):552-555.

Be safe,

R/R 911

[AnthonyM83]

(Remember, though, in France the ambulances are usually staffed by a physician.)

I know this is an aside, but I wonder how they're mortality/morbidity rates compare to the US for patients treated by an ambulance crew.

[medic001918]

My service does not provide us with the bougie, however it is in our protocol. I managed to get my hands on my own bougie that I carry in my pocket while on duty and wouldn't go on a shift without it. Also, like Rid said, any additional airway class should be taken. I've taken the DAMS (Difficult Airway Management in the Streets) class and felt it was one of the best 16 hours of CME's I had ever taken. It was filled with great discussion, immense hands on skills and all of it was good practical knowledge from experienced providers. Well worth the time and money.

Shane

NREMT-P

[kevkei]

I agree in that I think it is a great secondary device but it is only as good as the operator. It could probably be even better if people would use it appropriately. The most common problem I have seen that leads to unsuccessful attempts is removing the laryngoscope blade prior to ETT insertion. This creates greater difficulty passing the ETT because it allows for a larger amount of soft tissue to obstruct the tube and create an obsticle course.

It also works well in patients that are moderately anterior where you can see the base of the cords but can't get the tip of the tube around the tight angle despite the use of a stylette, curving the tip and trying to angle the tube up using the tongue or bottom teeth.

[flight-lp]

The bougie is awesome and I use it regularly for grade III and grade IV airways. It is simple to use if properly trained as is better than retrograde intubation as it is not invasive. I hope to see more utilize it in the pre-hospital environment............

[vs-eh?]

Apparently our flight guys and their base hospital physician swear by it.

[northernmedic]

We started carrying it a year ago and i've used it twice on big bloody trauma airways and loved it. They're dirt cheap I don't know why more agencies don't use it. It's way cheaper than other stuff like view max etc.

[Airmedic999]

I think bougies are underused the world over in pre - hospital care. We should all bougie on down as it is certainly a technique that can get you out of serious trouble now and again.

[retired_medic61]

Its like the American Express card...don't leave home without it :wink:

[mommaparamedic]

Our service has it and I love it. If I am not mistaken it only cost like 5.95.