The esophageal tracheal combitube as a non-invasive alternative to endotracheal intubation. A review.
The esophageal tracheal combitube (ETC) is a supraglottic airway device that functions as an effective alternative to ventilation via mask and tracheal intubation and is therefore a valuable tool in difficult and emergency airway management. The Com-bitube has proven to be a valuable tool for securing the airways and providing adequate ventilation. Its advantages are that it is easy to insert quickly, it may be inserted blindly or with the aid of a laryngoscope, and it provides adequate ventilation and oxygenation in both esophageal and tracheal position. The combitube allows application of high ventilatory pressures and it minimises the risk of aspiration. Several guidelines including European Resuscitation Council, Ame-rican Heart Association, American Society of Anesthesiologists have included the combitube as a primary rescue device in cannot ventilate cannot intubate situations. It has been used in elective patients as well as in emergency situations in- and out-of-hospital. The combitube can be inserted with minimal movement of the cervical spine and is therefore indicated whenever cervical spine movement is anatomically restricted (e.g. rheumatoid arthritis) or should be functionally restricted (e.g. trauma). Since the combitube isolates the lungs from the esophagus it is especially useful in patients at risk for aspiration (e.g., caesarean section, morbid obesity). The combitube is available in two sizes: 37 F SA (Small Adult) and 41 F. Unfortunately, a pediatric size is not commercially available. Training in the use of the combitube under controlled conditions is prerequisite to being expert in an emergency situation. The combitube is another non-surgical airway in the armamentarium of the anaesthesiologist or emergency provider in case of foreseen or unforeseen difficult airways in patients who can neither be intubated or mask ventilated.