The Combitube—also known as the esophageal tracheal airway or esophageal tracheal double-lumen airway—is a
blind insertion airway device
A blind insertion airway device (BIAD or blind insertion device) is a medical device used for airway management that ensures an open pathway between a patient's lungs and the outside world, as well as reducing the risk of aspiration, which can ...
(BIAD) used in the pre-hospital and emergency setting.
[Jorge E. Zamora and Tarit K. Saha,]
Combitube rescue for cesarean delivery followed by ninth and twelfth cranial nerve dysfunction
Canadian Journal of Anesthesia Volume 55, Issue 11 , pp 779-784, published 2008 It is designed to provide an
airway
The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.
Air is breathed in through the nose to th ...
to facilitate the
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move air ...
of a patient in
respiratory distress
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
.
Description and use
It consists of a cuffed, double-lumen tube that is inserted through the patient's mouth to secure an airway and enable
ventilation
Ventilation may refer to:
* Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation
** Mechanical ventilation, in medicine, using artificial methods to assist breathing
*** Ventilator, a m ...
. Generally, the distal tube (tube two, clear) enters the
esophagus
The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...
, where the cuff is inflated and ventilation is provided through the proximal tube (tube one, blue) which opens at the level of the
larynx
The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...
. In the rare instance where the distal tube intubates the
trachea
The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
, ventilation is provided through the distal tube. Inflation of the cuff in the esophagus allows a level of protection against
aspiration of gastric content similar to that found in the
laryngeal mask.
The simplicity of placement is the main advantage of the Combitube over
endotracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently ...
. 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 and cranial nerve dysfunction
associated with their use.
While it has been suggested as an option by the
American Heart Association
The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate cardiac care in an effort to reduce disability and death ...
and
European Resuscitation Council
The European Resuscitation Council (ERC) is the European Interdisciplinary Council for Resuscitation Medicine and Emergency Medical Care
Emergency medicine is the medical speciality concerned with the care of illness
A disease is a ...
for situations where intubation attempts are unsuccessful since the year 2000,
[International Liaison Committee on Resuscitation/European Resuscitation Council Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care—Part 6, Section 3: adjuncts for oxygenation, ventilation, and airway control ''Resuscitation'', 46 (2000), pp. 115–125] 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 the
laryngeal mask airway
A laryngeal mask airway (LMA), also known as laryngeal mask, is a medical device that keeps a patient's airway open during anaesthesia or while they are unconscious. It is a type of supraglottic airway device. They are most commonly used by anae ...
, the
endotracheal tube
A tracheal tube is a catheter that is inserted into the Vertebrate trachea, trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate Gas exchange, exchange of oxygen and carbon dioxide.
Many diffe ...
, and the
laryngeal tube
The laryngeal tube (also known as the King LT)
, ''University of Toronto, Department of Anesthesia'' Website retrieved ...
.
See also
*
Laryngeal tube
The laryngeal tube (also known as the King LT)
, ''University of Toronto, Department of Anesthesia'' Website retrieved ...
*
Endotracheal tube
A tracheal tube is a catheter that is inserted into the Vertebrate trachea, trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate Gas exchange, exchange of oxygen and carbon dioxide.
Many diffe ...
*
Airtraq
Airtraq is a fibreoptic intubation device used for indirect (video or optic assisted) tracheal intubation in difficult airway situations. It is designed to enable a view of the glottic opening without aligning the oral with the pharyngeal, and ...
References
Further reading
* Ron Walls, Michael Murphy
Extraglottic devices ''Manual of Emergency Airway Management'', Lippincott Williams & Wilkins, 05.11.2012.
External links
Combitube.org
{{Emergency medicine
Airway management
Emergency medical equipment