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Esophageal - tracheal COMBITUBE. „Pharyngeal“ lumen No. 1. Perforations. Distal cuff. „Esophago- tracheal“ lumen No. 2. Oropharyngeal balloon. Large (blue) syringe: 85 ml large balloon. Elbow deflector. Distal cuff. Ringmarks. Oropha- ryngeal ballon. Small syringe:

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Esophageal - tracheal

COMBITUBE

„Pharyngeal“

lumen No. 1

Perforations

Distal

cuff

„Esophago-

tracheal“

lumen No. 2

Oropharyngeal

balloon


Large (blue) syringe:

85 ml large balloon

Elbow deflector

Distal

cuff

Ringmarks

Oropha-

ryngeal

ballon

Small syringe:

10 ml distal cuff

Suction catheter


Open

mouth,

press

away

tongue

Head:

Neutral

position


Flat

insertion

along

tongue


Elective cases:

Elective cases:

Emergency:

No. 2: 10 ml

Emergency:

No. 1: 85 ml

(or more)

Ringmarks

at level of

upper teeth


Ventilation

via longer

blue tube

No. 1

Esophageal

position

Self-

fixation

behind

hard palate

Active

decom-

pression


Tracheal

position

Ventilation

via shorter

clear

tube

No. 2


Lipp maneuver

Markus Lipp

University Mainz


Frass Maneuver


Urtubia Maneuver


Combitube

Produced by:

TYCO -

HEALTHCARE KENDALL

Mansfield, MA


Size of COMBITUBE and height of patient

GUIDELINES*

STUDIES**

*TYCO

**Gaitini, Urtubia,

Panning, Krafft


Combitube

Specially useful:

  • Difficult intubation

  • Blind intubation

  • Difficult circumstances

    (space, illumination)


Indications Combitube

  • Emergency intubation

  • Bleeding and vomiting

  • Immediate decompression

    of esophagus and stomach


Combitube 37 SA:

ALL - IN - ONE

CONCEPT


Conclusions

the 37 Fr Combitube SA is...

  • the “standard“ Combitube

  • safe and efficient

  • insertion under direct vision recommended

  • slow inflation of oropharyngeal balloon

  • inflation volume: height (cm) - 100 or weight (kg) - 5

  • suitable for all patients in whom tracheal

  • intubation has to be avoided


FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS.

Blostein, Koestner, Hoak

J Trauma 1998; 44: 534-537

  • Use of ETC in trauma pts. in whom orotracheal rapid sequence intubation failed

  • Flight nurses trained with ETC

  • 12 pts. had ETC, 10 included


FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS.

  • Successful in all patients

  • Definitive airway control in ED: orotracheal (7), tracheostomy (2), cricothyroidotomy (1)

  • 7 mandible fractures, 4 TBI, 2 fa-cial fractures, 1 hemopneumoth


Paramedic

-Main indication-

  • Bridge between BVM and endotracheal tube


COMPLICATIONS ASSOCIATED WITH THE USE OF THE COMBITUBE

  • 1139 pts. CPR with ETC + SAED

  • 2 pts. transparietal lacerations of anterior wall of esophagus

  • Distal cuff inflated with 20 to 40 ml !!! Maximum 12 ! CPR; CPPV

Vézina, Lessard, Bussières, et al.

Can J Anaesth 1998; 45:76-80


USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS

Lefrançois DP, Dufour DG

Resuscitation 2002; 52:77-83

  • 420 Emergency medical technicians + automatic external defibrillator (EMT-Ds)

  • Firefighters with BLS-D

  • 125-350 h course curriculum for EMTs

  • 18 h training with AED and Combitube

  • Assessment of location with EDD (syringe) + auscultation


USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS

  • Montérégie / Quebec: 11,000 square km, population of 1.3 million

  • Successful placement in 725 out of 760 cardiac arrest patients (95.4 %)

  • Ventilation successful in 695 (91.4 %) pts.

  • Autopsy in 133 pts.: no esophageal lesions or injury to airway structures

  • EMT-Ds can use ETC safely + effectively


Merits of COMBITUBE

  • Low price, all-in-one device

  • Non invasive

  • No preparations necessary

  • Rapid and easy intubation

  • Immediate fixation

  • PREVENTION OF ASPIRATION

  • HIGH VENTILATORY PRESSURES

  • No power supply


American Heart Association

Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care

JAMA 1992; 268:2203

2 / 2000: Class IIa DEVICE !!!


American Society of Anesthesiologists

Task Force on

Management of the

Difficult Airway.

Practice Guidelines

for Management of

the Difficult Airway.

Anesthesiology

1993; 78:597-602


European Resus-citation Council

Baskett PJF, Bossaert L, Carli P, Chamberlain D, Dick W, Nolan JP, Parr MJA, Scheidegger D, Zideman D: Guidelines for the advanced management of the airway and ventilation during resuscitation. Resuscitation 1996; 31:201-230


ConclusionCOMBITUBE

  • Whenever endotracheal intubation not immediately possible

  • Short training time

  • Adequate ventilation


Combitube® - Homepage:

  • http://www.combitube.org

    or

  • http://www.combitube.net

    Webmaster: Roland Hofbauer


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