What is it about?

Placing a breathing tube in an unconscious or anaesthetised is a critical skill, which can be challenging, especially if the patient's airway is difficult due to anatomical or time constraints. One way that is described to improve success is to use a breathing tube introducer (a bendable "stylet" to shape the tube, or a very flexible "bougie" to guide it around corners). However, there was not strong evidence from studies to show that this really makes a difference. We designed a test using a medical manikin to simulate easy and difficult airways, and had paramedics, emergency doctors and anaesthesiologists of varying experience place the breathing tubes with four different methods.

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Why is it important?

The results clearly showed that while a breathing tube (endotracheal tube) introducer might not make a big difference in routine/easy airways, if difficulty is encountered, it makes a very large difference: 30 vs 95 % success on the first go, or getting 9 out of 10 first time rather than just 1 in 3.


Although this was a simulated study in "plastic people" (manikins), it included over 900 breathing tube placements by 117 experienced doctors, and showed a very clear result. This in itself is reason to advise that we should always use an introducer for difficult or emergency cases, and provides an excellent foundation for studying the problem ethically in real patients.

Dr Ross Hofmeyr
Department of Anaesthesia & Perioperative Medicine, University of Cape Town

Read the Original

This page is a summary of: Comparison of four methods of endotracheal tube passage in simulated airways: There is room for improved techniques, Emergency Medicine Australasia, November 2017, Wiley,
DOI: 10.1111/1742-6723.12874.
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