Performance of novice intubators in using direct laryngoscope with 3 stylets on a manikin model

Background: Tracheal intubation is an important clinical skill for medical students and junior residents (novice intubators). They are usually trained to use a direct laryngoscope (DL) with straight-to-cuff styletted tracheal tubes first. Only later are they exposed to the bougie as an airway adjunct and videolaryngoscope (VL) with either a standard blade or a hyperangulated blade. The purpose of this study was to investigate the performance of novice intubators in using DL with 3 common stylets. Methods: We conducted a prospective study to compare the performance of DL with 3 common stylets, namely the straight-to-cuff stylet (S), hyperangulated VL stylet (G), and bougie (B), on a manikin model. Results: Among 72 participants, no significant difference was observed between the success rates of S, G, and B at the first attempt (84.72%, 81.94%, and 86.11%, respectively [P = .78]) or within 2 minutes (91.67%, 93.06%, and 91.67%, respectively [P = .94]). For participants with successful intubation within 2 minutes, the average total intubation times for S, G, and B were 25.05, 24.39, and 37.45 seconds, respectively. Among the 3 stylets, B had the longest intubation time, which differed significantly from S and G (P < .01). Conclusions: The performances of novice intubators with 3 different stylets were similar. The success rates for DL with either hyperangulated VL stylet or bougie were not inferior compared with the straight-to-cuff stylet on manikin airway training model. If we properly trained novice intubators to use corresponding maneuvers, they can learn to use the 3 stylets early in their airway learning course.