Comparison of Traditional Bougie Versus Kiwi-D Grip Bougie Technique During Mechanical Chest Compressions: A Randomized Crossover Manikin Trial.

Background: Investigators have reported bougie use improves first-pass intubation success rates when compared to the endotracheal (ET) tube/stylet technique. We aimed to assess the difference in time to intubation and operator confidence between the Kiwi-D grip bougie and traditional bougie technique during simulated mechanical cardiopulmonary resuscitation (mCPR).

Methods: This study was a prospective, randomized comparative study at a simulation center. Consenting emergency physicians were surveyed about intubation experience, and provided structured practice for techniques. Subjects performed direct laryngoscopy (DL) using a Mac 4 blade (Karl Storz SE & Co. KG, Tuttlingen, Germany) on an adult manikin with a moderately difficult airway, during simulated mCPR (LUCAS 3.0, Stryker Corporation, Kalamazoo, MI, USA) at 100 compressions/min. Each subject was intubated using Kiwi-D and traditional bougie techniques, respectively, in a randomized order. A study author measured intubation time (blade pick up until cuff inflation) and assessed intubation success. Subjects rated intubation success confidence on a five-point scale and provided Cormack/Lehane grade. Categorical data was analyzed by chi-square and continuous data by t-tests for bivariate analyses. Multivariate linear regression was performed for intubation time. Non-parametric Wilcoxon signed-rank test was performed for the ordinal categorical variables.

Results: There were 31 subjects; 87% with one to five years of experience, 52% preferred DL during CPR, 71% preferred the traditional no-preload bougie technique, and 48% had utilized a bougie >10 times. Subjects had first-pass intubation success for all but one attempt with both modalities (NS). For Kiwi-D versus traditional bougie, 48% of subjects rated a higher level of confidence for successful intubation (p=0.01), and 29% (p=0.1) reported improved glottic view. Mean time to intubation was similar for Kiwi-D versus traditional (20.6+/-9 versus 25.3+/-17s; p=0.06). The following subject characteristics were not associated with improved intubation time for Kiwi-D: 6+ years of experience (p=0.6), >10 prior intubations with a bougie (p=0.6), preloading bougie preference (p=0.4), and DL preference (p=0.4). Multivariate linear regression did not identify subject variables that were significantly associated with Kiwi-D use for improved intubation time with Kiwi-D.

Conclusion: Subjects in our study group did not have significant differences in time to intubation using Kiwi-D versus traditional bougie during simulated mCPR.