Driver BE, et al. - The Bougie Use in Emergency Airway Management (BEAM) trial was intended to compare first attempt intubation success facilitated by the bougie vs the endotracheal tube + stylet among patients with difficult airways undergoing emergency intubation. Researchers reported that use of a bougie compared with an endotracheal tube + stylet resulted in significantly higher first-attempt intubation success among patients undergoing emergency endotracheal intubation in this Emergency Department, however, these findings should be considered provisional until the generalizability was assessed in other institutions and settings.

Methods

• From September 2016 through August 2017, the BEAM trial was a randomized clinical trial conducted in the Emergency Department at Hennepin County Medical Center, an urban, Academic Department in Minneapolis, Minnesota, where emergency physicians perform all endotracheal intubations.
• In this analysis, researchers involved patients who were 18 years and older and who were consecutively admitted to the Emergency Department and underwent emergency orotracheal intubation with a Macintosh laryngoscope blade for respiratory arrest, difficulty breathing, or airway protection.
• Patients were randomly assigned to undergo the initial intubation attempt facilitated by bougie (n = 381) or endotracheal tube + stylet (n = 376).
• First-attempt intubation success in patients with at least 1 difficult airway characteristic (body fluids obscuring the laryngeal view, airway obstruction or edema, obesity, short neck, small mandible, large tongue, facial trauma, or the need for cervical spine immobilization) was the primary outcome.
• First-attempt success in all patients, first-attempt intubation success without hypoxemia, first-attempt duration, esophageal intubation, and hypoxemia were the secondary outcomes.

Results

• As per data, among seven hundred fifty-seven patients who were randomized (mean age, 46 years; women, 230 [30%]), 757 patients (100%) completed the trial.
• First-attempt intubation success was higher in the bougie group (96%) than in the endotracheal tube + stylet group (82%) (absolute between-group difference, 14% [95% CI, 8% to 20%]) among the 380 patients with at least 1 difficult airway characteristic.
• First-attempt intubation success in the bougie group (98%) was higher than the endotracheal tube + stylet group (87%) (absolute difference, 11% [95% CI, 7% to 14%]) among all patients.
• Findings revealed that the median duration of the first intubation attempt (38 seconds vs 36 seconds) and the incidence of hypoxemia (13% vs 14%) did not differ significantly between the bougie and endotracheal tube + stylet groups.