A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators

John Cormack; Bridget Langley; Louisa-Rose Bhanabhai; Roman Kluger

doi:10.1186/s12245-020-00298-6

A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators

Int J Emerg Med. 2020 Jul 17;13(1):38. doi: 10.1186/s12245-020-00298-6.

Authors

John Cormack^{1

2}, Bridget Langley^{3

4}, Louisa-Rose Bhanabhai⁴, Roman Kluger^{3

4}

Affiliations

¹ The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Building 181, Grattan St, Melbourne, 3010, Australia. cormackj@ozemail.com.au.
² Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, PO Box 2900, Fitzroy, VIC 3065, Australia. cormackj@ozemail.com.au.
³ The Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Building 181, Grattan St, Melbourne, 3010, Australia.
⁴ Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, PO Box 2900, Fitzroy, VIC 3065, Australia.

Abstract

Background: This unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the "Flexible Tip Bougie" (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%. Participants were Emergency Medicine and Anaesthesia trainees with recent experience of less than twenty patient intubations. The primary outcome was time to intubation, further divided into time taken to pass the ETI and time to railroad the endotracheal tube (ETT) over the ETI. The secondary outcome was the difficulty of intubation.

Results: The median total time to ETT placement was significantly shorter with the FTB (37.5 s) compared with the FROVA ETI (63.0 s), P = 0.0006. The median difficulty reported (scores 0-10 with 0 being no difficulty) with the FTB was 2 compared with 5 for the FROVA, P < 0.0001.

Conclusions: The FTB enabled significantly faster and easier placement of the endotracheal tube compared with the FROVA in inexperienced hands intubating a difficult intubation manikin.

Keywords: Airway management; Intratracheal intubation; Manikin; Teaching materials.