The Bougie as an Airway Savior

The Bougie as an Airway Savior 150 150 Richie Cunningham

Ever since the BEAM (Bougie Use in Emergency Airway Management) trial was published in JAMA in 2018, the use of the bougie has become increasingly mainstream.1 Some of the advantages of using a bougie are known, but there are also misconceptions about its use, how to maximize success with it, and why we should be using it for most, if not all, airways. We’ll summarize that here.

Background

The use of the gum elastic bougie was first described in a 1949 letter by Dr. R.R. Macintosh (of whose eponymous laryngoscope blade we are all familiar).2 In that letter, Dr. Macintosh wrote about using what was essentially a urinary catheter. The term “gum elastic bougie” is actually somewhat of a misnomer; the most common form of the bougie as we know it was introduced in 1973 as the Eschmann tracheal tube introducer, and it is not made of gum, not elastic, and not a bougie (at least with respect to the original medical definition, that being a cylindrical instrument meant for introduction into the urethra or other tubular structures in order to dilate constrictures).3 Nevertheless, the name has stuck.

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