Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis
Authors: Rafael von Hellmann, Natalia Fuhr, Ian Ward A Maia, Danielle Gerberi, Daniel Pedrollo, Fernanda Bellolio, Lucas Oliveira J E Silva
Journal: Annals of Emergency Medicine, September 20, 2023
Conclusion:
- Bougie use in the first intubation attempt was associated with increased success.
- Despite low certainty of evidence, the data suggest that a bougie should probably be used first, not as a rescue device, in emergency intubations.
Methods:
- Study Design: Systematic review and meta-analysis.
- Included Studies: RCTs and comparative observational studies evaluating adults intubated with and without a bougie.
- Excluded Studies: Manikin and cadaver studies.
- Data Sources: Ovid Cochrane Central, Ovid Embase, Ovid Medline, Scopus, Web of Science.
- Analysis: Meta-analysis with random-effects models, GRADE assessment for certainty of evidence.
Results:
- 2,699 studies screened, 133 selected for full-text review, and 18 underwent quantitative analysis.
- Bougie use was associated with increased first-attempt intubation success (pooled RR 1.11, 95% CI 1.06 to 1.17, low certainty evidence).
- Subgroup Analysis: Similar effect estimates across all subgroups, including emergency intubations.
- Highest point estimate favoring bougie use was in patients with Cormack-Lehane III or IV (RR 1.60, 95% CI 1.40 to 1.84, moderate certainty).