title: Difficulties with gum elastic bougie intubation in an academic emergency department.
abstract: BACKGROUND
  The difficulties with gum elastic bougie (GEB) use in the emergency department (ED) have never been studied prospectively.
  
  
  OBJECTIVE
  To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED.
  
  
  METHODS
  We conducted a prospective, observational study of GEB practices in our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000 patients. Laryngoscopists performing a GEB-assisted intubation completed a structured data form after laryngoscopy, recording patient characteristics, grade of laryngeal view (using the modified Cormack-Lehane classification), reason for GEB use, and problems encountered. Data were analyzed using standard statistical methods and 95% confidence intervals.
  
  
  RESULTS
  A GEB was used for 88 patients. The overall success rate was 70/88 (79.6%; 95% confidence interval [CI] 71.1-88.0%). The GEB failure rate of the first laryngoscopist was 25/88 (28.4%; 95% CI 21.0-40.3%), with the two most common reasons being: inability to insert the bougie past the hypopharynx in 13 (52%; 95% CI 32.4-71.6%) and inability to pass the endotracheal tube over the bougie in six (24%; 95% CI 7.3-40.7).
  
  
  CONCLUSIONS
  The GEB is a helpful rescue airway device, but emergency care providers should be aware that failure rates are relatively high at a teaching institution.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Kaushal H
authors.initials: KH
authors.lastname: Shah
authors.forename: Brian
authors.initials: B
authors.lastname: Kwong
authors.forename: Alberto
authors.initials: A
authors.lastname: Hazan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Batista
authors.forename: David H
authors.initials: DH
authors.lastname: Newman
authors.forename: Dan
authors.initials: D
authors.lastname: Wiener
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D004868:Equipment Failure; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies