Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 3/2022

Open Access 31-07-2021 | Review Article

Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis

Authors: Jaden Tollman, Zubair Ahmed

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2022

Login to get access

Abstract

Purpose

Tracheal tube introducers and stylets remain some of the most widely used devices for aiding practitioners in performing endotracheal intubation (ETI). The purpose of this systematic review is to evaluate the efficacy of tracheal tube introducers and stylets for ETI in the prehospital setting.

Methods

A literature search was conducted on the 2nd of March 2021 across PubMed, Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies. Included studies had their data extracted and both a quality assessment and statistical analysis were performed.

Results

The summary estimate of prehospital studies with video technology showed a statistically significant increase in first pass ETI success in favour of bougies (RR 1.15, CI 1.10–1.21, p < 0.0001). The summary estimates of prehospital studies without video technology and simulation studies with and without video technology showed no statistical difference between methods for first pass or overall ETI success. Some of the highest success rates were recorded by devices that incorporated video technology. Stylets lead to a shorter time to ETI while bougies were easier to use. Neither device was associated with a higher rate of ETI complications than the other.

Conclusion

Both tracheal tube introducers and stylets function as efficacious aids to intubation in the prehospital environment. Where video technology is available, bougies could offer a statistically significant advantage in terms of first pass ETI success. Where video technology is unavailable, a combination of clinical scenario, practitioner expertise and personal preference might ultimately guide the choice of device.
Appendix
Available only for authorised users
Literature
1.
Lockey D, Healey B, Crewdson K, Chalk G, Weaver A, Davies G. Advanced airway management is necessary in prehospital trauma patients. Br J Anaesth. 2015;114(4):657–62.CrossRef
2.
3.
Crewdson K, Lockey D, Røislien J, Lossius H, Rehn M. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. Crit Care. 2017;21(1):1.CrossRef
4.
Grape S, Schoettker P. The role of tracheal tube introducers and stylets in current airway management. J Clin Monit Comput. 2016;31(3):531–7.CrossRef
5.
Kerslake D, Oglesby A, Di Rollo N, James E, McKeown D, Ray D. Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations. Resuscitation. 2015;89:20–4.CrossRef
6.
Lecky F, Bryden D, Little R, Tong N, Moulton C. Emergency intubation for acutely ill and injured patients. Cochrane Database of Systematic Reviews. 2008.
7.
8.
Apfelbaum J, Hagberg C, Caplan R, Blitt C, Connis R, Nickinovich D, et al. Practice guidelines for management of the difficult airway. Anesthesiology. 2013;118(2):251–70.CrossRef
9.
10.
Sheu Y, Yu S, Huang T, Liu F, Lin Y, Tam K. Comparison of the efficacy of a bougie and stylet in patients with endotracheal intubation: a meta-analysis of randomized controlled trials. J Trauma Acute Care Surg. 2019;86(5):902–8.CrossRef
11.
Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339(jul21 1):b2535–b2535.CrossRef
12.
13.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRef
14.
Bonnette A, Aufderheide T, Jarvis J, Lesnick J, Nichol G, Carlson J, et al. Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial. Resuscitation. 2021;158:215–9.CrossRef
15.
Ångerman S, Kirves H, Nurmi J. A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation. Anaesthesia. 2018;73(3):348–55.CrossRef
16.
Jabre P, Combes X, Leroux B, Aaron E, Auger H, Margenet A, et al. Use of gum elastic bougie for prehospital difficult intubation. Am J Emerg Med. 2005;23(4):552–5.CrossRef
17.
Karaca O, Bayram B, Oray N, Acerer A, Sofuoglu Z. Comparison of the airway access skills of prehospital staff in moving and stationary ambulance simulation: a randomized crossover study. Turk J Emerg Med. 2017;17(2):35–41.CrossRef
18.
Phelan M, Moscati R, D’Aprix T, Miller G. Paramedic use of the endotracheal tube introducer in a difficult airway model. Prehosp Emerg Care. 2003;7(2):244–6.CrossRef
19.
Cooney D, Beaudette C, Clemency B, Tanski C, Wojcik S. Endotracheal intubation with a video-assisted semi-rigid fiberoptic stylet by prehospital providers. Int J Emerg Med. 2014;7(1):1.CrossRef
20.
Heegaard W, Black C, Pasquerella C, Miner J. Use of the endotracheal tube introducer as an adjunct for oral tracheal intubation in the prehospital setting. AirMed. 2003;22(1):28–31.
21.
Combes X, Jabre P, Margenet A, Merle J, Leroux B, Dru M, et al. Unanticipated difficult airway management in the prehospital emergency setting. Anesthesiology. 2011;114(1):105–10.CrossRef
22.
Woollard M, Lighton D, Mannion W, Watt J, McCrea C, Johns I, et al. Airtraq vs standard laryngoscopy by student paramedics and experienced prehospital laryngoscopists managing a model of difficult intubation. Anaesthesia. 2007;63(1):26–31.CrossRef
23.
Messa M, Kupas D, Dunham D. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care. 2011;15(1):30–3.CrossRef
24.
Evrin T, Smereka J, Gorczyca D, Bialka S, Ladny J, Katipoglu B, et al. Comparison of different intubation methods in difficult airways during simulated cardiopulmonary resuscitation with continuous chest compression: a randomized cross-over manikin trial. Emerg Med Int. 2019;2019:1–7.
25.
Gregory P, Woollard M, Lighton D, Munro G, Jenkinson E, Newcombe R, et al. Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation. Anaesthesia. 2012;67(4):371–6.CrossRef
26.
Le D, Reed D, Weinstein G, Gregory M, Brown L. Paramedic use of endotracheal tube introducers for the difficult airway. Prehosp Emerg Care. 2001;5(2):155–8.CrossRef
27.
De Jong A, Molinari N, Conseil M, Coisel Y, Pouzeratte Y, Belafia F, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40:629.PubMed
28.
Howard-Quijano K, Huang Y, Matevosian R, Kaplan M, Steadman R. Video-assisted instruction improves the success rate for tracheal intubation by novices. Br J Anaesth. 2008;101(4):568–72.CrossRef
29.
Lockey D, Deakin C. Pre-hospital trauma care: systems and delivery. Contin Edu Anaesth Crit Care Pain. 2005;5(6):191–4.CrossRef
30.
Maurin Söderholm H, Andersson H, Andersson Hagiwara M, Backlund P, Bergman J, Lundberg L, et al. Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory. Adv Simul. 2019;4(1):1.CrossRef
31.
Beleña J, Gasco C, Polo C, Vidal A, Núñez M, Lopez-Timoneda F. Laryngeal mask, laryngeal tube, and frova introducer in simulated difficult airway. J Emerg Med. 2015;48(2):254–9.CrossRef
32.
Lutes M, Worman D. An unanticipated complication of a novel approach to airway management. J Emerg Med. 2010;38(2):222–4.CrossRef
33.
Vollmer T, Stewart R, Paris P, Ellis D, Berkebile P. Use of a lighted stylet for guided orotracheal intubation in the prehospital setting. Ann Emerg Med. 1985;14(4):324–8.CrossRef
Metadata
Title
Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis
Authors
Jaden Tollman
Zubair Ahmed
Publication date
31-07-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01762-5

Other articles of this Issue 3/2022

European Journal of Trauma and Emergency Surgery 3/2022 Go to the issue

Original Article

Conservative treatment of ulnar styloid fractures following volar-plate fixation of distal radius fractures: incidence of nonunion evaluated by computed tomography

Original Article

Total hip arthroplasty for failed acetabular fracture: a double-center comparative study on failed proximal femur fracture

Original Article

A long-term experience with Mutars tumor megaprostheses: analysis of 187 cases

Original Article

The impact of BMI on morbidity and mortality after femoral fractures

Original Article

Continuous enteral protease inhibition as a novel treatment for experimental trauma/hemorrhagic shock

Original Article

The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery