To stylet or bougie?

Posted on September 3, 2012

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David Lighton with students Rennelle Libline, left, and Hannah Lancaster demonstrating the assisted breathing apparatus and stylet. The blue tube is a bougie.

It’s a decision with serious ramifications for saving more lives at roadside emergencies.

An international study has identified the best equipment for paramedics to use on patients who have stopped breathing and have obstacles in their airways.

A team of paramedicine experts from Britain and Australia researched different types and brands of instruments used in a procedure known as ‘tracheal intubation’ – inserting a tube into the trachea – to try and restore breathing for such patients.

They identified which intubation methods and brands were most effective in conditions unique to those faced by paramedics.

Research team member and recently appointed La Trobe lecturer in paramedicine David Lighton, says paramedics deal with different issues than other health workers when treating patients with blocked airways.

That’s because most health professionals work in controlled medical environments such as hospitals, while paramedics face unique challenges on the roadside, he says.

‘Advancing a flimsy breathing tube past the narrow and sensitive tissues of the vocal cord in a patient with breathing difficulties is tricky. So we use a hand held device called a laryngoscope.

Research into three instruments

‘The laryngoscope is fitted with a light or camera for extra visibility. But the procedure can still be very hard to administer if there are obstacles such as a swollen tongue or airway,’ says Mr Lighton.

What works in hospital may not be best on the road

The research team tested three instruments to ascertain the most effective equipment available to paramedics. These were stylets, disposable bougies and reusable bougies.

Their study, ‘Comparison of malleable stylet and reusable and disposable bougies by paramedics in a simulated difficult intubation,’ has been published by British Medical Journal Anaesthesia.

‘On the one hand you have reusable and disposable bougies which are long, thin and flexible, and which help to find a safe pathway down the throat and into the opening of the lungs. Some brands of bougies are more flexible than others.

‘On the other hand you have stylets, which perform the same role as bougies but which are much more rigid.’

Stylets more effective

The researchers asked experienced paramedics to perform the procedure on manikins with swollen tongues and neck braces that bent the airway at an inconvenient angle.

‘We found that stylets are more effective than bougies and that single use bougies are more effective than reusable bougies,’ says Mr Lighton.

The researchers were surprised when their study showed that the disposable bougies got better results than their reusable counterparts.

‘That goes against common sense. You would think that something that was designed for multiple usages would be more effective.’

Mr Lighton hopes that this information can be used by ambulance services to purchase the best equipment possible.

More about paramedicine at La Trobe