I have used a bougie a few times when removing the King in the ED although we usually have a fiber optic scope handy if there is evidence of bleeding/trauma although that is more common with the Combitube. Luckily (?), very few patients survive who have a Combitube to where ETI will be needed as most of these codes are called shortly after arrival to the ED. Those that do look like we might gain ROSC will need the tubes changed as will those who have inadequate ventilation. Those are a pain to change due to the tissue damage and air that has inflated the belly (aspiration) by poor placement and bagging to see which tube is in. We have ramped up our available intubating technology in the ED with the increased use of the supraglottic. Back when ETI was still a popular and well performed skill, most of the time all I needed was a tube changer to assist in inserting one of the hospital's ETTs.
If you are considering the removal of a device that is working in the field before you reach the hospital, you will want to consider the risks carefully. The supraglottic devices can cause just enough irritation, especially if inserted in less than ideal situations by people who are not well trained in their use, that may make ETI difficult.
If ROSC is obtained, a 6.0 mm will not be adequate to maintain an adult of average size on a ventilator for very long and will also have to be changed. Even in a very small slight built adult, a 6.5 mm is at the bottom limit of effectiveness. Of course in EMS one may have to do whatever for an airway.
