Comparing the utility of the weighted Corflo® and the Comforsoft® nasogastric feeding tubes in administering activated charcoal: A randomised, cross-over, non-inferiority manikin study

Activated charcoal is administered through a nasogastric tube to some poisoned patients, but occasionally the insertion of unweighted nasogastric tube fails in the emergency department. Weighted nasogastric tube with a stylet, for example, the Corflo® nasogastric tube, facilitates insertion, but it is not clear whether it would impede activated charcoal delivery. We aimed to compare the utility of the Corflo® and usual (Comforsoft®) nasogastric tubes in administering activated charcoal in manikins. This was a single-centre, randomised, single-blinded, crossover manikin non-inferiority trial involving 28 participants. Each participant administered 50 g of activated charcoal using the Corflo® and Comforsoft® nasogastric tubes in a random sequence interspersed with a 2-hour washout period. We compared the difference in the time required for activated charcoal administration with a pre-defined non-inferiority margin of 300 seconds and the perceived level of effort between the two nasogastric tubes. The mean time for administering 50 g of activated charcoal through the Comforsoft® and the Corflo® nasogastric tube were 87.1 s and 301.6 s, respectively. The mean difference of 203.2 s (95% confidence interval: 147.5–258.9, p < 0.001) was within the non-inferiority margin. The perceived level of effort was significantly higher with the Corflo® nasogastric tube (mean effort score 7.0 vs 1.4, p < 0.001). Our study provides experimental data to support the use of the Corflo® nasogastric tube as a non-inferior alternative to the usual nasogastric tube in administering activated charcoal to poisoned emergency department patients. More studies are warranted to verify the findings and optimise the settings for AC administration.