Impact of stylet use in a simulated difficult airway model.

Background: Stylet use during endotracheal intubation (ETI) is variable across medical specialty and geographic location; however, few objective data exist regarding the impact of stylet use on ETI performance.

Objective: We evaluated the impact of stylet use on the time required to perform ETI in cases of simulated difficult airways in novice and experienced providers.

Methods: We performed a prospective, randomized observational study of experienced (attending anesthesiologists and emergency physicians) vs inexperienced airway providers (emergency medical technician, paramedic and medical students) comparing the use of stylet vs no stylet in random order using a simulated difficult airway. The primary outcome was attempt time for each of 6 attempts defined as entry of the laryngoscope in the mouth until successfully passing the endotracheal tube past the vocal cords. We analyzed the data using descriptive statistics including means with SDs and t tests. We used generalized estimating equations to evaluate potential changes in the attempt time over multiple attempts.

Results: There were 23 providers per group. The mean (SD) inexperienced attempt time in seconds was 25.88 (28.46) and 10.50 (5.47) for experienced providers (P < .0001). Stylet use did not alter attempt time for either group. When adjusting for stylet use, the attempt time did not change over repeated intubations (P = .541). When adjusting for experience status, inexperienced intubators had shorter attempt times with each successive trial, whereas experienced intubators attempt times remained constant (P < .001).

Conclusion: Stylet use does not improve attempt time in a simulated difficult airway model for either inexperienced or experienced intubators.