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 t ...

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 a ...

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 disc ...

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. 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 t ...

, 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 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 from t ...

, 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 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 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 frequentl ...

. 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 deat ...

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, the

endotracheal tube A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes ar ...

, and the

laryngeal tube The laryngeal tube (also known as the King LT)
, ''University of Toronto, Department of Anesthesia'' Website retrieved ...

References

External links

Combitube.org

{{Emergency medicine Airway management Emergency medical equipment

Description and use

See also

References

Further reading

External links