Combitube: The all-in-one concept for securing the airway and adequate ventilation

Abstract

I can do it every time, everywhere, under all circumstances within 3 minutes. This was the standard statement we have heard from anesthesiologists and intensivists regarding conventional endotracheal intubation when we first created the Combitube about 15 years ago. In the meantime, interest has changed and there is enthusiasm for alternatives to endotracheal intubation in the last few years. Let us talk about the beginning of the Combitube. Endotracheal intubation is the world-wide accepted gold standard for airway management. It directly connects the ventilation devices to the respiratory tract and provides a tight seal. However, endotracheal intubation may be difficult or impossible even for skilled anesthesiologists on some occasions. Therefore, the Esophageal-Tracheal Combitube (ETC; Tyco-Kendall, Mansfield, MA) has been established as a simple and efficient alternative in foreseen but especially also in unforeseen difficult situations, providing safe securing of the airway as well as sufficient oxygenation and ventilation. The method of esophageal obturation was first described by Dr. Zarda in 1796 ~ in Prague and was first implemented in the esophageal obturator airway (EOA) in 1968 by Don Michael and Gordon as an alternative to the endotracheal airway designed for emergency intubation. 2 The EOA is a 34-cm long single-lumen tube with a conventional balloon at its distal end. The distal end is blocked and, at the pharyngeal level, the tube shows 16 perforations. The EOA is inserted gently into the esophagus. Air is blown through a connector in the