To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED.
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.
A GEB was used for 88 patients. The overall success rate was 70/88 (79.6 % ; 95 % confidence interval [CI] 71.1?8.0 % ). The GEB failure rate of the first laryngoscopist was 25/88 (28.4 % ; 95 % CI 21.0?0.3 % ), with the two most common reasons being: inability to insert the bougie past the hypopharynx in 13 (52 % ; 95 % CI 32.4?1.6 % ) and inability to pass the endotracheal tube over the bougie in six (24 % ; 95 % CI 7.3?0.7).
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.