Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Objective: Endotracheal intubation (ETI) in children requires good techniques and experience. Gum elastic bougie (GEB) is a practical, inexpensive, easy-to-use airway method in the adult airway. Through GEB, ETI is a method that can be learned after a short training. We evaluated the effectiveness of this method, which has not yet been validated in pediatric patients in prehospital pediatric airway applications.
Material and Methods: This study was designed as a study simulating the prehospital period with a mankin. Practitioners were asked to perform intubation by conventional intubation or GEB.
Results: This study was conducted with 48 emergency medical technicians and paramedics. Four (8.3%) of the practitioners had experience using GEB. In terms of first-pass success, no difference was found between ETI via GEB and Macintosh blade conventional ETI [91.7% (44/48), 93.8% (45/48), respectively, p=1.000]. Use of GEB increased ETI time [28.6±6.0 sec vs. 17.1±4.0 sec, mean df: 11.3 sec (95% CI: 9.7-12.8), p<0.001]. While 87.6% of the practitioners evaluated the use of GEB as very easy and easy, 83.3% of the practitioners evaluated the traditional method as very easy and easy (p=0.914).
Conclusion: GEB does not make any difference in pediatric airway management in terms of first-pass success. However, the use of GEB in terms of ETI durations increases the duration of ETI. Besides, the use of GEB is seen as a method that can be applied more efficiently, even in inexperienced groups.

Keywords: Airway control, gum elastic bougie, pediatric, pre-hospital