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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 December;67(12):863-74

language: English

The esoph­a­geal tra­cheal com­bi­tube as a non-inva­sive alter­na­tive to endo­tra­cheal intu­ba­tion (A ­review)

Agrò F., Frass M. *, Benumof J. **, Krafft P. *, Urtubia R. ***, Gaitini L. ****, Giuliano I.

From the Department of Anesthesia, University School of Medicine Campus Bio-Medico - Rome (Italy)
*Department of Anaesthesia and Intensive Care Medicine University of Vienna (Austria)
**University of California at San Diego Medical Center San Diego, CA (USA)
***Department of Anaesthesia Intensive ­Care and Anesthesia Unit Mutual de Seguridad Hospital, ­CCHC Alameda, Santiago (Chile)
****Department of Anaesthesia University School of Medicine Rosario (Argentina)


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.

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