NextGen Learning To Elevate Your Airway Practice
Some Good Evidence (A Timeline)
1949: Introduction of the Bougie in Airway Management
- Sir Robert Macintosh published a case report describing the novel use of a gum elastic urinary catheter as an endotracheal tube introducer to facilitate difficult tracheal intubation. Wikipedia
1973: Development of the Eschmann Endotracheal Tube Introducer
- P. Hex Venn, inspired by Macintosh’s work, developed the Eschmann endotracheal tube introducer, commonly known as the bougie, which became widely used in difficult intubations. Wikipedia
2000: Study on Bougie Use in Failed Intubations
- A study by Moscati et al. demonstrated the effectiveness of the bougie as a rescue device in failed intubation attempts, highlighting its value in emergency airway management. Pubmed
2018: BEAM Trial
- The Bougie Use in Emergency Airway Management (BEAM) trial found that bougie use resulted in significantly higher first-attempt intubation success compared to the endotracheal tube with stylet, particularly in patients with difficult airway characteristics. PMC
2024: Systematic Review and Meta-Analysis
- A systematic review and meta-analysis published in the Annals of Emergency Medicine concluded that bougie use is associated with increased first-attempt intubation success across various settings, supporting its routine use in emergency airway management. Annals of Emergency Medicine
🔑 Key Takeaways: These milestones underscore the bougie’s evolution from a simple introducer to an essential tool in airway management, supported by substantial evidence of its efficacy in improving intubation success rates.
✅ Higher First-Pass Success – The BEAM trial (2018) and multiple systematic reviews confirm that bougie-assisted intubation significantly outperforms stylet-guided intubation, particularly in patients with difficult airway characteristics.
✅ Proven in Difficult Airways – When vocal cords are partially or barely visible (Cormack-Lehane Grade 2-3 views), the bougie helps guide tube placement with greater accuracy.
✅ Faster, More Reliable Rescue – In failed first attempts, the bougie provides a simple and effective rescue strategy, reducing the need for multiple intubation attempts and the associated risks of hypoxia and airway trauma.
✅ Endorsed by Guidelines – Major organizations like the Difficult Airway Society (DAS), the American Society of Anesthesiologists (ASA), and emergency medicine protocols recommend the bougie as a first-line tool for difficult airways.
Designed for Tracheal Access
You may ask, “How can a simple piece of plastic be that important? Do I even need to learn about tube introducers in the age of VL? I thought they were a relic of direct laryngoscopy.” Well, not so fast. Let’s discuss the bougie’s design features that help explain why they remain valuable to your airway practice.
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The Bottom Line
The evidence is clear: using a bougie improves first-pass success rates, especially in difficult airways. Studies spanning decades have consistently shown that the bougie enhances intubation success when direct visualization is limited, making it a critical tool in emergency, prehospital, and operating room settings. The Verdict? If you manage airways, you should know how to use a bougie. If you’re not using one routinely, use it as a backup. The device is simple, and learning the skill to use it is straightforward. Mastering it could make all the difference.
What’s Next
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Return to the Source
Dive into some of the most intriguing and practice-changing papers published on this topic. We’ve gone to the source and collected what we think you should know.
References
- Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. Brian E Driver 1, Matthew E Prekker 1 2, Lauren R Klein 1, Robert F Reardon 1, James R Miner 1, Erik T Fagerstrom 1, Mitchell R Cleghorn 3, John W McGill 1, Jon B Cole 1 JAMA; 018 Jun 5;319(21):2179-2189. doi: 10.1001/jama.2018.6496.
- Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting Andrew J. Latimer, MD Brenna Harrington, Catherine R. Counts, PhD, MHA Charles Maynard, PhD Taketo Watase, MD Michael R. Sayre, MD Published:December 17, 2020DOI: https://doi.org/10.1016/j.annemergmed.2020.10.016
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