Bougie vs Stylet – The BEAM Trial

Written by Alex Chen, MD

Spoon Feed
First attempt success was higher in the bougie group vs stylet group (98% vs 87% in all comers, 96% vs 82% in patients with at least one difficult airway characteristic). The median duration of the first-attempt as well as incidence of hypoxemia was similar between bougie and stylet groups.

Why does this matter?
We often use the bougie as an adjunct device for challenging airways. This study looks at the utility of a bougie for all comers and whether that extra step improves outcomes without increasing time to intubation or complications.

BEAM me up, Scotty!
This was a RCT conducted at Hennepin County Medical Center with 757 patients. They randomized patients to either bougie or ETT+stylet for initial attempt. Intubations were performed by mostly senior ED residents or fellows using a Macintosh blade (majority with C-MAC)

First-attempt success was better in the bougie group, with no statistically significant difference in terms of the duration of the attempt. Overall, rates of hypoxemia were similar between bougie and stylet groups (13% vs 14%); however, there was less hypoxemia during the first-attempt in the bougie group.

This study gives the first RCT data on the utility of the bougie as a primary intubation device. These results may not be generalizable if you do not have a similar set-up in your hospital or are not comfortable using the bougie. I would like to see this study repeated in more centers, but this is pretty compelling data in support of using the bougie first.

Source
Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial.  JAMA. 2018 May 16. doi: 10.1001/jama.2018.6496. [Epub ahead of print]
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Reviewed by Thomas Davis