Esophageal Tracheal Combitube Research Articles

Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients.

The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia. This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications. Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5-3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0-2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4-3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6-3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1-1.9). We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.

Prehospital Use of the Esophageal Tracheal Combitube Supraglottic Airway Device: A Retrospective Cohort Study.

In the province of Quebec (Canada), paramedics use the esophageal tracheal Combitube (ETC) for prehospital airway management. Our main objective was to determine the proportion of patients with successful ventilation achieved after ETC use. Our secondary aim was to determine the number of ETC insertion attempts required to ventilate the patient. This is a retrospective cohort study. All patients who had ≥1 attempt to insert an ETC during prehospital care between January 1, 2017 and December 31, 2018 were included. Prehospital and in-hospital data were extracted. Successful ventilation was defined as thorax elevation, lung sounds on chest auscultation, or positive end-tidal capnography after ETC insertion. A total of 580 emergency medical services interventions (99.3% cardiac arrests) were included. Most patients were men (62.5%) with a mean age 67.0 years (SD 17.6 years), and 35 (13.1%) of the 298 patients transported to emergency department survived to hospital discharge. Sufficient information to determine whether ventilation was successful or not was available for 515 interventions. Ventilation was achieved during 427 (82.7%) of these interventions. The number of ETC insertion attempts was available for 349 of the 427 successful ETC use. Overall, the first insertion resulted in successful ventilation during 294 interventions for an overall proportion of first-pass success ranging between 57.1% and 72.1%. Proportions of successful ventilation and ETC first-pass success are lower than those reported in the literature with supraglottic airway devices. The reasons explaining these lower rates and their impact on patient-centered outcomes need to be studied.

To breathe or not to breathe: a review of artificial airway placement and related complications.

Artificial airway devices are commonly used to provide adequate ventilation and/or oxygenation in multiple clinical settings, both emergent and nonemergent. These frequently used devices include laryngeal mask airway, esophageal-tracheal combitube, endotracheal tube, and tracheostomy tube and are associated with various acute and late complications. Clinically, this may vary from mild discomfort to a potentially life-threatening situation. Radiologically, these devices and their acute and late complications have characteristic imaging findings which can be detected primarily on radiographs and computed tomography. We review appropriate positioning of these artificial airway devices and illustrate associated complications including inadequate positioning of the endotracheal tube, pulmonary aspiration, tracheal laceration or perforation, paranasal sinusitis, vocal cord paralysis, post-intubation tracheal stenosis, cuff overinflation with vascular compression, and others. Radiologists must recognize and understand the potential complications of intubation to promptly guide management and avoid long-term or even deadly consequences.

Supraglottic Airways: The History and Current State of Prehospital Airway Adjuncts

This review discusses the history, developments, benefits, and complications of supraglottic devices in prehospital care for adults and pediatrics. Evidence supporting their use as well as current controversies and developments in out-of-hospital cardiac arrest and rapid sequence airway management is discussed. Devices reviewed include the Laryngeal Mask Airway, Esophageal Tracheal Combitube, Laryngeal Tube, I-Gel, Air-Q, Laryngeal Mask Airway Fastrach, and the Supraglottic Airway Laryngopharyngeal Tube (SALT).

Trial of Grading for Villitis of Unknown Etiology (VUE) due to Pathological investigation

To evaluate the ease of use of two airway devices, the EasyTube (EzT) versus the esophageal-tracheal Combitube (ETC).Prospective, randomized controlled trial.University hospital.80 adult, ASA physical status 1 and 2 patients scheduled for elective surgery.Patients’ tracheas were intubated with the EzT or the ETC in randomized fashion.Difficulty of insertion, time to achieve an effective airway, insertion success rate, maneuvers to achieve an effective airway, oropharyngeal leak pressure, intracuff pressure, ventilatory parameters, success rate of gastric tube insertion, and frequency of adverse effects were compared.Insertion was easier in the EzT than in ETC; insertion of the EzT was rated easy in 36 7cases and moderately difficult in 4 cases versus 26 and 14 cases, respectively, for the ETC (P = 0.014). Less time was required to achieve an effective airway with the EzT than the ETC: 19.4 ± 5.3 sec versus 30.6 ± 4.1 seconds, respectively (P < 0.001). Oropharyngeal leak pressure was higher with the EzT than the ETC (34.3 ± 5.95 vs 31.6 ± 2.42 cm H2O; P = 0.011). Peak airway pressures for the EZT and the ETC were 22.2 ± 0.99 cm H20 and 33.7 ± 1.82 cm H2O, respectively (P < 0.001). Gastric tube insertion was successful with both devices; however, the EzT allowed insertion of gastric tubes of wider diameter. No severe perioperative adverse events were recorded for either device.The EzT has distinct advantages over the ETC in airway management, including shorter time to achieve an effective airway and easier insertion.

Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation

Study Objective To evaluate the ease of use of two airway devices, the EasyTube (EzT) versus the esophageal-tracheal Combitube (ETC). Design Prospective, randomized controlled trial. Setting University hospital. Subjects 80 adult, ASA physical status 1 and 2 patients scheduled for elective surgery. Interventions Patients’ tracheas were intubated with the EzT or the ETC in randomized fashion. Measurements Difficulty of insertion, time to achieve an effective airway, insertion success rate, maneuvers to achieve an effective airway, oropharyngeal leak pressure, intracuff pressure, ventilatory parameters, success rate of gastric tube insertion, and frequency of adverse effects were compared. Main Results Insertion was easier in the EzT than in ETC; insertion of the EzT was rated easy in 36 7cases and moderately difficult in 4 cases versus 26 and 14 cases, respectively, for the ETC ( P = 0.014). Less time was required to achieve an effective airway with the EzT than the ETC: 19.4 ± 5.3 sec versus 30.6 ± 4.1 seconds, respectively ( P < 0.001). Oropharyngeal leak pressure was higher with the EzT than the ETC (34.3 ± 5.95 vs 31.6 ± 2.42 cm H 2O; P = 0.011). Peak airway pressures for the EZT and the ETC were 22.2 ± 0.99 cm H 20 and 33.7 ± 1.82 cm H 2O, respectively ( P < 0.001). Gastric tube insertion was successful with both devices; however, the EzT allowed insertion of gastric tubes of wider diameter. No severe perioperative adverse events were recorded for either device. Conclusion The EzT has distinct advantages over the ETC in airway management, including shorter time to achieve an effective airway and easier insertion.

Part 8: Advanced Life Support

Part 8: Advanced Life Support

Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations

A Meta-Analysis of Prehospital Airway Control Techniques Part II: Alternative Airway Devices and Cricothyrotomy Success Rates

Background. Airway management is a key component of prehospital care for seriously ill and injured patients. Oral endotracheal intubation (OETI) is the definitive airway of choice in most emergency medical services (EMS) systems. However, OETI may not be an approved skill for some clinicians or may prove problematic in certain patients because of anatomic abnormalities, trauma, or inadequate relaxation. In these situations alternative airways are frequently employed. However, the reported success rates for these devices vary widely, and established benchmarks are lacking. Objective. We sought to determine pooled estimates of the success rates of alternative airway devices (AADs) and needle cricothyrotomy (NCRIC) and surgical cricothyrotomy (SCRIC) placement through a meta-analysis of the literature. Methods. We performed a systematic literature search for all English-language articles reporting success rates for AADs, SCRIC, and NCRIC. Studies of field procedures performed by prehospital personnel from any nation were included. All titles were reviewed independently by two authors using prespecified inclusion criteria. Pooled estimates of success rates for each airway technique were calculated using a random-effects meta-analysis model. Results. Of 2,005 prehospital airway titles identified, 35 unique studies were retained for analysis of AAD success rates, encompassing a total of 10,172 prehospital patients. The success rates for SCRIC and NCRIC were analyzed across an additional 21 studies totaling 512 patients. The pooled estimates (and 95% confidence intervals [CIs]) for intervention success across all clinicians and patients were as follows: esophageal obturator airway–esophageal gastric tube airway (EOA-EGTA) 92.6% (90.1%–94.5%); pharyngeotracheal lumen airway (PTLA) 82.1% (74.0%–88.0%); esophageal-tracheal Combitube (ETC) 85.4% (77.3%–91.0%); laryngeal mask airway (LMA) 87.4% (79.0%–92.8%); King Laryngeal Tube airway (King LT) 96.5% (71.2%–99.7%); NCRIC 65.8% (42.3%–83.59%); and SCRIC 90.5% (84.8%–94.2%). Conclusions. We provide pooled estimates for prehospital AAD, NCRIC, and SCRIC airway interventions. Of the AADs, the King LT demonstrated the highest insertion success rate (96.5%), although this estimate is based on limited data, and data regarding its ventilatory effectiveness are lacking; more data are available for the ETC and LMA. The ETC, LMA, and PTLA all had similar—but lower—success rates (82.1%–87.4%). NCRIC has a low rate of success (65.8%); SCRIC has a much higher success rate (90.5%) and should be considered the preferred percutaneous rescue airway.

How Much Force Is Required to Dislodge an Alternate Airway?

Introduction. Endotracheal tube (ETT) dislodgment is a potentially catastrophic adverse event. Newer alternate airway devices—esophageal-tracheal Combitube (ETC), King laryngeal tube disposable airway (King LT), and laryngeal mask airway (LMA)—are easier to insert, but their relative extubating forces remain unknown. Objective. To examine the applied forces required to dislodge an ETC, King LT, LMA, and ETT. Methods. We used five recently deceased adult unembalmed cadavers. In random order, we sequentially inserted an ETC, King LT, LMA, and standard ETT. Because commercial tube holders are not designed for all alternate airways, we secured the devices with a standard adhesive tape method. Using a precision digital force measuring device, we measured the minimum manually applied axial force (lb) that dislodged each airway device at least 4 cm. We compared required dislodgment forces between airway devices using a mixed-effects regression model, adjusting for cadaver height, weight, neck circumference, and thyromental distance. Results. Characteristics of the cadavers were as follows (median, interquartile range [IQR]): height 172 cm (167–177), weight 98 kg (84–120), neck circumference 46.5 cm (41–52), and thyromental distance 7.5 cm (7.5–8). Required axial dislodgment forces for each airway device were as follows (median, IQR): ETC 28.3 lb (19.0–28.6), King LT 12.5 lb (11.7–13.3), LMA 18.3 lb (14.0–21.9), and ETT 14.4 lb (13.5-22.1). The ETC required twice as much dislodgment force as the ETT (adjusted difference 16.7 lb, 95% confidence interval [CI]: 8.3 to 25.1). The King LT and LMA dislodgment forces were similar to that of the ETT (King LT vs. ETT adjusted difference 5.9 lb, 95% CI: –2.4 to 14.2; LMA vs. ETT 8.1 lb, 95% CI: –0.2 to 16.5). Conclusion. In a cadaver model of unintended airway dislodgment, the ETC required the most force for dislodgment. The King LT and LMA performed similarly to a standard ETT.

Laryngeal Tube® pilot balloon kinking in the presence of a bite block

To the Editor, Supraglottic airway devices are being developed with increasing frequency following the overwhelming success of the Laryngeal Mask Airway (LMA). The LMA, the ProSeal Laryngeal Mask Airway (PLMA), the Laryngeal Tube (LT), the Laryngeal Tube with integrated suctioning (LTS) and the Esophageal Tracheal Combitube (OTC) are currently the most evaluated and widespread supraglottic airway devices. The Laryngeal Tube (VBM Medizintechnik, Sulz, Germany) is a relatively new supraglottic device designed to secure a patent airway during either spontaneous breathing or controlled ventilation. The manufacturer’s standard LT has since been redesigned and modified to incorporate a suction port. The standard LT consists of an airway tube with a small distal cuff attached at the tip and a larger balloon proximal cuff located at the middle part of the tube (Fig. 1). The cuffs are inflated through a single pilot tube and balloon through which inflation pressure can be monitored. There are three black lines on the tube close to a standard 15 mm connector to indicate adequate depth of insertion when aligned with the teeth. The device is inserted while the patient’s head and neck are placed either in the sniffing position or in a neutral position. The tip of a well-lubricated LT is placed against the patient’s hard palate behind the upper incisors. The device is then advanced through the centre of the mouth until either resistance is felt or the device is almost fully inserted. The LT is inserted properly when the second bold black line on the tube has just passed between the upper and lower incisors. A bite block is inserted when ventilation is adequate, and the LT is secured in its wedge. Both are fixed in place with an elastic strap supplied with the device set. Once it is correctly placed with the bite block and the provided elastic strap, the LT will maintain its intended position after insertion. We have used the LT extensively for 3 years in at least 250 cases conducted under general anesthesia in all age groups. The device is used routinely to maintain the patient’s airway, either during spontaneous breathing or controlled ventilation. Although the cuff deflator is applied correctly, we have noted each time that the pilot balloon cuff is not deflated immediately before the LT is removed. We have observed that the pilot balloon tube continually slips and tightens in the groove between the LT shaft and the M. Singh, MD (&) Government Medical College Hospital, Chandigarh, India e-mail: manpreetdawar@hotmail.com

Use of the video laryngoscopy for Combitube exchange in a difficult airway

Following failed intubation attempts via conventional direct laryngoscopy, an Esophageal Tracheal Combitube was successfully placed in the esophagus of a 51-year-old man with a subdural hematoma and uncleared cervical spine. The decision was made to change the Combitube for an endotracheal tube (ETT). After deflation of the large oropharyngeal cuff of the Combitube, video laryngoscopy was performed with the Direct Coupled Interface (DCI) video intubation system, and the Combitube was exchanged for an ETT with the assistance of a gum elastic bougie.

Students insert the laryngeal tube quicker and more often successful than the esophageal–tracheal combitube in a manikin

Background Endotracheal intubation remains the standard of airway management. Because intubation skills are difficult to acquire, for medical students teaching of easier to learn techniques should be considered. Methods We retrospectively analyzed data that were collected in a University teaching facility. 264 medical students were taught how to use laryngeal tube (LT) and Esophageal Tracheal Combitube ® (ETC) in a manikin. The students underwent one of two different types of extraglottic airway management training consisting of either long lecture (30 min) and intensive training (2 h) (group IT, n = 48), or brief (10 min) lecture and 20 min of training (group BT, n = 216). Both groups underwent a test 6 weeks after training, group IT had an additional test 24 h after training. Results After 24 h students in group IT were faster using the LT than the ETC (31.7 s ± 2.1 vs. 51.9 s ± 5.8, p < 0.001). Up to 6 weeks after training students were able to place the LT significantly faster than the ETC in both groups (26.5 s ± 2.1 vs. 53.9 s ± 5.8 group IT and 43.4 s ± 1.6 vs. 103.8 s ± 4.4 group BT, p < 0.001). At 24 h and 6 weeks following intensive training, there was no statistical difference in the time required for insertion of either device. Conclusion Following different training scenarios in a manikin, students were able to place the LT much faster than the ETC. Even brief training was sufficient to generate short insertion times for the LT.

Effect of Emergency Medical Technician–Placed Combitubes on Outcomes After Out-of-Hospital Cardiopulmonary Arrest

Objective. While emergency medical technicians–basic (EMT-Bs) in select emergency medical services (EMS) agencies use the Esophageal Tracheal Combitube (ETC) for the airway management of out-of-hospital cardiopulmonary arrests, the effect of this intervention on patient outcomes is not known. We compared the associations between initial EMT ETC placement and initial paramedic endotracheal intubation (ETI) on patient survival after out-of-hospital cardiopulmonary arrest. Methods. We utilized data on adult (age > 21 years), out-of-hospital cardiopulmonary arrests from a large, urban, county-based, two-tiered (EMT-B first responder, paramedic ambulance) EMS system for the years 1997–2005. EMT-Bs placed an ETC on cardiopulmonary arrest patients if they arrived before paramedics. Paramedics managed the airway primarily using ETI. We included cases in which rescuers accomplished ETC insertion or ETI on the first airway effort. We excluded cases in which an invasive airway was not used. We excluded cases with failed airway insertion or multiple airway efforts. We examined return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge. We evaluated the association between outcome and airway type (ETC vs. ETI) using multivariate logistic regression, adjusting for age, gender, bystander-witnessed arrest, bystander cardiopulmonary resuscitation (CPR), bystander automated external defibrillator (AED) use, initial electrocardiogram (ECG) rhythm, and response time. Results. Of 7,010 adult cardiopulmonary arrests, we excluded 747 cases without airway insertion and 441 cases involving failed or multiple airway efforts. Of the remaining 5,822 cardiopulmonary arrests, 4,335 (74%) received initial paramedic ETI and 1,437 (26%) received initial EMT-B ETC insertion. Compared with paramedic ETI, EMT-B ETC placement was not associated with ROSC (adjusted odds ratio [OR] 0.93; 95% confidence interval [CI]: 0.82–1.05), survival to hospital admission (adjusted OR 0.99; 95% CI: 0.86–1.13), or survival to hospital discharge (adjusted OR 1.02; 95% CI: 0.79–1.30). Conclusions. Compared with initial paramedic ETI, initial EMT-B ETC placement was not associated with patient survival after out-of-hospital cardiac arrest.

Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube

The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube (ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication. Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups (n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra-operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post-operative discomfort were recorded. The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more (P<0.01) as compared with Group B (17%). The incidence significantly increased (P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post-operative period in three patients in Group A and resolved spontaneously in <15 min in each case. Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak-proof oropharyngeal cavity.

Prediction of a Low Success Rate of Astronauts in Space in Performing Endotracheal Intubation

We certainly concur with Rabitsch et al. 1that tracheal intubation using direct laryngoscopy by astronauts in space is likely to have a high failure rate. Roan first presented this concept and the use of the Laryngeal Mask Airway ™ (LMA ™; LMA North America, Inc., San Diego, CA) as a backup emergency airway device to the National Aeronautics and Space Administration in October 1999*and later at the Aerospace Medical Association Conference in 2001.†In fact, since 2003, the LMA-Fastrach ™ has been used on the space shuttle as a backup airway device.Several reasons exist that predict a low success rate of astronauts in space in performing tracheal intubation. Although some crew medical officers (CMOs) are physicians, often the CMO may have no medical background. The training CMOs receive on the proper use of the bag valve mask resuscitator, oral airway, tracheal intubation, and surgical cricothyroidotomy is limited, and even physician CMOs are likely to have had several years pass since the last clinical exposure to this scenario. Studies have found that experienced emergency medical technicians (basic), with two to three times the amount of training provided to CMOs, have only approximately a 50% success rate of tracheal intubation in human subjects.2,3A compounding factor further increasing the likelihood of failed intubation is the condition of microgravity while in orbit.The ideal airway for astronaut CMOs would possess a very short learning curve as well as require little experience to master and maintain proficiency. Rabitsch et al. 1chose the Esophageal Tracheal Combitube® (Kendall Sheridan Healthcare Products Company, Argyle, NY) as a backup airway device for failed tracheal intubation. Although requiring less training and skill than direct laryngoscopy, the use of the Combitube® as a rescue airway for failed intubation has shown an overall complication rate of up to 40%, including failure to place, aspiration, pneumothorax, esophageal perforation and laceration, among others.4,5Also, the presence of two lumens may prove confusing to the relative novice under the many stressors of an emergency; clearly, the wrong lumen choice would have disastrous consequences.Although an oral airway and manual resuscitator with facemask is another option, it is well known that ventilation with this device can be challenging for even the most highly trained personnel. On the other hand, 100% of 32 nurses without previous experience in the use of the LMA ™ were able to successfully ventilate live patients 3 months after manikin-only training.6The complication rate of the LMA ™ is quite low, and when used as a primary airway rescue device for failed intubation, it has provided rescue ventilation without complication in 94% of failed intubation cases.7Although the standard LMA ™ has a high success rate as a conduit for tracheal intubation, the LMA-Fastrach ™ is specifically designed to facilitate this. Therefore, it was chosen for the shuttle orbiters and the International Space Station because it most closely meets the criteria delineated above of a short learning curve with a high success rate and easily maintained insertion proficiency.‡University of Alabama at Birmingham, Birmingham, Alabama. gboyd@uab.edu

An Out-of-hospital Comparison of the King LT to Endotracheal Intubation and the Esophageal-Tracheal Combitube in a Simulated Difficult Airway Patient Encounter

An Out-of-hospital Comparison of the King LT to Endotracheal Intubation and the Esophageal-Tracheal Combitube in a Simulated Difficult Airway Patient Encounter

Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

The Esophageal-Tracheal Combitube (Combitube) is widely used for the management of the airway during cardiopulmonary resuscitation in the pre-hospital setting. Although serious complications have been reported with the Combitube, there is a paucity of data relative to the frequency and nature of such complications. The objective of this retrospective study was to determine the incidence and the nature of complications associated to the Combitube in the pre-hospital setting. Since 1993, in the Quebec City Health Region, the basic life support treatment algorithm for emergency medical technicians has included the use of a Combitube as the primary airway device for management of all patients presenting with cardiac or respiratory arrest. The database of the emergency coordination services was searched for the period between 1993 and 2003 (2,981 patients). Only those patients who survived at least 12 hr were included. Medical records of these patients were reviewed to identify complications related to the use of the Combitube. Two-hundred-eighty (280) patients were identified. Fifty-eight (58) patients (20.7%, confidence interval (CI)95%=16.0%-25.4%) presented 69 complications: aspiration pneumonitis (n=31), pulmonary aspiration (n=16), pneumothorax (n=6), upper airway bleeding (n=4), esophageal laceration (n=3), sc emphysema (n=2), esophageal perforation and mediastinitis (n=2), tongue edema (n=2), vocal cord injury (n=1), tracheal injury (n=1), and pneumomediastinum (n=1). Thirteen of these complications (12 patients, 4.3%, CI95%=2.0%-6.3%) were judged as most likely resulting from trauma associated with insertion of the Combitube. The use of the Combitube in the pre-hospital setting is associated with a notable incidence of serious complications.

Does the type of out-of-hospital airway interfere with other cardiopulmonary resuscitation tasks?

Out-of-hospital rescuers often perform tracheal intubation (TI) prior to other cardiopulmonary resuscitation (CPR) interventions. TI is a complex and error-prone procedure that may interfere with other key resuscitation tasks. We compared the effects of TI versus esophageal tracheal combitube (ETC) insertion on the accomplishment of other interventions during simulated cardiopulmonary resuscitation. In this prospective trial using a human simulator, two-paramedic teams simulated resuscitation of a ventricular fibrillation cardiopulmonary arrest using standard Advanced Cardiac Life Support guidelines. In each of two trials, teams used either TI or ETC as the primary airway device. Following delivery of three rescue shocks, we measured time intervals to successful airway placement, intravenous (IV) line insertion, drug administration, delivery of fourth rescue shock and completion of all four tasks. We also measured the total time without chest compressions. We compared task completion times using non-parametric statistics (Wilcoxon signed-ranks test) with a Bonferroni-adjusted p-value of 0.008. Twenty teams each completed two scenarios. Participants required a median of 172.5 s (IQR: 146.5-225.5) to accomplish all four tasks. Elapsed time to airway placement was significantly less for ETC than TI (median difference 26.5 s (IQR 13-44.5), p=0.002). Time without chest compressions was less for ETC than TI (median difference 8.5 s (IQR 2.5-23.5), p=0.005). There were no differences between ETC and TI in times to IV placement (median difference 23.5 s (IQR -20 to 61), p=0.11), drug delivery (39.5 s (IQR -18 to 63), p=0.07), delivery of fourth rescue shock (39.5 s (IQR -21.5 to 87.5), p=0.07) or completion of all four tasks (33 s (IQR -11 to 74.5), p=0.08). Compared with TI, ETC reduced time to airway placement and time without chest compressions, but did not affect elapsed times to accomplish other interventions. Additional time differences may be realized if translated to clinical out-of-hospital conditions.

Combitube to the Rescue

To help elucidate the possible role of the esophageal-tracheal Combitube as a rescue airway device, an investigator reviewed a database of emergency