| Combitube | |
|---|---|
 | |
| Synonyms | esophageal tracheal airway, esophageal tracheal double-lumen airway |
| Specialty | Anesthesiology,Emergency medicine |
| Intervention | Airway management |
| Related items | laryngeal mask airway,laryngeal tube |
TheCombitube—also known as theesophageal tracheal airway oresophageal tracheal double-lumen airway—is ablind insertion airway device (BIAD) used in the pre-hospital and emergency setting.[1] It is designed to provide anairway to facilitate themechanical ventilation of a patient inrespiratory distress.
It consists of a cuffed, double-lumen tube that is inserted through the patient's mouth to secure an airway and enableventilation. Generally, the distal tube (tube two, clear) enters theesophagus, where the cuff is inflated and ventilation is provided through the proximal tube (tube one, blue) which opens at the level of thelarynx. In the rare instance where the distal tube intubates thetrachea, ventilation is provided through the distal tube. Inflation of the cuff in the esophagus allows a level of protection againstaspiration of gastric content similar to that found in thelaryngeal mask.[2]
The simplicity of placement is the main advantage of the Combitube overendotracheal intubation. When intubating with a traditional endotracheal tube, care must be taken to visually ensure that the tube has been placed in the trachea while the dual-lumen design of the Combitube allows for ventilation to proceed regardless of esophageal or tracheal placement.
A device called the Positube, which allows for esophageal intubation detection, can be used on tube number two to rule out the intubation of the Combitube in the trachea. The Positube checks for air flow resistance on tube number two and is very helpful in checking proper Combitube placement when intubation is performed in noisy environments.
The Combitube's ease of use makes it an option for use in the pre-hospital, emergency setting when advanced level providers capable of placing an endotracheal tube are not immediately available. The drawbacks of Combitubes are evidenced by reports of serious complications such as aspiration, esophagus perforation[3] and cranial nerve dysfunction[1] associated with their use.
While it has been suggested as an option by theAmerican Heart Association andEuropean Resuscitation Council for situations where intubation attempts are unsuccessful since the year 2000,[4] it is seldom used outside of the pre-hospital, emergency setting, as it does not allow for long term airway control. Alternatives to the Combitube include thelaryngeal mask airway, theendotracheal tube, and thelaryngeal tube.
