Using a Bougie With C-MAC Video Laryngoscopy Did Not Improve First-Attempt Intubation Success Rates in Critical Care Air Transport

Objective: Studies have shown a bougie improves first-attempt success rates when used in combination with direct laryngoscopy during the initial attempt. The purpose of this study was to determine whether the use of a bougie in combination with C-MAC (Karl Storz, Tuttlingen, Germany) improves first-attempt success rates of endotracheal intubation (ETI) compared with C-MAC with a traditional stylet. Methods: This study is a retrospective chart review using data collected on 371 intubations completed by a single air medical service using the C-MAC laryngoscope and either a bougie or a stylet. Results: The overall success rate using C-MAC for ETI with either a bougie or a stylet was 83%. There was no statistically significant difference between first-attempt successful intubations using C-MAC and a bougie (82%) or a stylet (86%) (χ¹ = 0.871, P = .351). There was no statistically significant difference between laryngoscopy grade and the number of attempts that resulted in a successful intubation (χ¹ = 0.743, P = .7). Conclusion: There was no difference between first-attempt success rates using video laryngoscopy with a bougie, overall intubation success rates, or difficult intubation success rates compared with video laryngoscopy with a stylet, indicating that the purpose of a bougie as a rescue device did not hold true in the prehospital setting of our critical care air medical service.