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Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway

Published online by Cambridge University Press:  28 June 2012

Thomas R. Calkins ,
Ken Miller  and
Mark I. Langdorf
Thomas R. Calkins
Affiliation:
Department of Emergency Medicine, University of California-Irvine, California, USA
Ken Miller
Affiliation:
Orange County Fire Authority, and Orange County Emergency Medical Services Agency, California, USA
Mark I. Langdorf*
Affiliation:
Department of Emergency Medicine, University of California-Irvine, California, USA
*
Correspondence:Dr.Mark I. Langdorf Department of Emergency Medicine University of California Irvine Medical Center 101 The City Drive Orange, California 92868 USA E-mail: [email protected]
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Abstract

Introduction:

Previous studies have proven the success of the EsophagealTracheal Combitube (ETC) as a primary airway, but not as a rescue airway.

Objective:

The object of this study was to observe success and complication rates of paramedic placement of an ETC as a rescue airway, and to compare success rates with endotracheal tube (ETT) intubation. The primary outcome indicator was placement with successful ventilation. Complication rates, esophageal placement, and return of spontaneous circulation (ROSC) were secondary measures.

Methods:

A retrospective review of the records of patients who had ETC attempts by Emergency Medical Services (EMS) was conducted for a period of three years. Complications were defined a priori. The ETC is used primarily as rescue airway for a failed attempt at an endotracheal tube (ETT) intubation. A control group for ETT placements was drawn from the EMS quality assurance (QA) database for the same period.

Results:

Esophageal-Tracheal Combitube insertion was attempted on 162 patients, of which, 113 (70%) were successful, 46 (28%) failed, and the outcome of three (2%) was not recorded. Inability to place the ETC occurred in 29 (18%) patients, and accounted for 48% (22/46) of failures. The use of the ETC caused dental trauma in one patient, and one placement of the ETC was related to the onset of subcutaneous emphysema. Blood in the ETC from active upper gatrointestinal bleeding occurred in nine patients (6%), and four tubes (3%) became dislodged en route to the hospital. The a priori complication rate was 44/162 (27%). Inability to determine placement of the ETC due to emesis from both ports occurred in 21 cases. Combining these problems with the a priori complications, the overall rate was 40% (65/162). EsophagealTracheal Combitube location was noted in a subset of 90 charts, of which, 76 (84%) were esophageal, and 14 (16%) were tracheal. Thirteen of 126 (10%) patients in cardiac arrest had return of spontaneous circulation (ROSC) in the field after placement of the ETC. An ETT was attempted in 128 control patients, of which, 107 (84%) were successful, 21 (16%) failed (odds ratio (OR) for ETT vs. ETC = 2.1; 95% CI = 1.12–3.86).

Conclusion:

Despite a low ROSC rate, the complication and success rates of ETC are acceptable for a rescue airway device. Tracheal placement of the Combitube is uncommon, but requires fail-safe discrimination. Similar to previous reports, the success ratio for ETT was greater than for the ETC.

Keywords

airwaycomplicationemergency medical services (EMS)endotracheal tube (ETT)Esophageal-Tracheal Combitube (ETC)placementreturn of spontaneous circulationventilation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 2 , April 2006 , pp. 97 - 100
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

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References

1Kurola, J, Harve, H, Kettunen, T, et al. : Airway management in cardiac arrest— Comparison of the laryngeal tube, tracheal intubation and bag-valve mask ventilation in emergency medical training. Resuscitation 2004;61:149–153.CrossRefGoogle ScholarPubMed
2Frass, M, Frenzer, R, Rauscha, F, et al. : Evaluation of esophageal-tracheal Combitube in cardiopulmonary resuscitation. Crit Care Med 1987;15:609–611.CrossRefGoogle ScholarPubMed
3Frass, M, Frenzer, R, Zdrahal, F, et al. : The Esophageal-Tracheal Combitube: Preliminary results with a new airway for CPR. Ann Emerg Med 1987;16:768–772.CrossRefGoogle ScholarPubMed
4Frass, M, Frenzer, R, Rauscha, F, et al. : Ventilation with the esophageal-tracheal Combitube in cardiopulmonary resuscitation. Promptness and effectiveness. Chest 1988;93:781–784.CrossRefGoogle ScholarPubMed
5Frass, M, Johnson, JC, Atherton, GL, et al. : Esophageal-Tracheal Combitube (ETC) for emergency intubation: Anatomical evaluation of ETC placement by radiography. Resuscitation 1989;18: 95–102.CrossRefGoogle ScholarPubMed
6Frass, M, Rodler, S, Frenzer, R, et al. : Esophageal-Tracheal Combitube, endotracheal airway, and mask: Comparison of ventilatory pressure curves. J Trauma 1989;29:1476–1479.CrossRefGoogle ScholarPubMed
7Frass, M, Staudinger, T, Losert, H, Krafft, P: Airway management during cardiopulmonary resuscitation—A comparative study of bag-valve-mask, laryngeal mask airway and Combitube in a bench model. Resuscitation 1999;43:80–81.Google Scholar
8Ochs, M, Vilke, GM, Chan, TC, et al. : Successful prehospital airway management by EMT-Ds using the combitube. Prehosp Emerg Care 2000;4:333–337.CrossRefGoogle ScholarPubMed
9Rumball, CJ, MacDonald, D: The PTL, Combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997;1:1–10.CrossRefGoogle ScholarPubMed
10Tanigawa, K, Shigematsu, A: Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998;2:96–100.CrossRefGoogle Scholar
11Vilke, GM, Steen, PJ, Smith, AM, Chan, TC: Out-of-hospital pediatric intubation by paramedics: The San Diego experience. J Emerg Med 2002;22:71–74.CrossRefGoogle ScholarPubMed
12Jacobs, LM, Berrizbeitia, LD, Bennett, B, Madigan, C: Endotracheal intubation in the prehospital phase of emergency medical care. JAMA 1983;250:2175–2177.CrossRefGoogle ScholarPubMed
13Rich, JM, Mason, AM, Bey, TA, et al. : The critical airway, rescue ventilation, and the Combitube: Part 1. AANA J 2004;72:17–27.Google ScholarPubMed
14Rich, JM, Mason, AM, Bey, TA, et al. : The critical airway, rescue ventilation, and the Combitube: Part 2. AANA J 2004;72:115–24.Google ScholarPubMed
15Michael, TA: The role of the esophageal obturator airway in cardiopulmonary resuscitation. Circulation 1986;74:IV134–137.Google ScholarPubMed
16Hankins, DG, Carruthers, N, Frascone, RJ, et al. : Complication rates for the esophageal obturator airway and endotracheal tube in the prehospital setting. Prehosp Disast Med 1993;8:117–121.CrossRefGoogle ScholarPubMed
17Gertler, JP, Cameron, DE, Shea, K, Baker, CC: The esophageal obturator airway: Obturator or obtundator? J Trauma 1985;25:424–426.CrossRefGoogle ScholarPubMed
18Smith, JP, Bodai, BI, Seifkin, A, et al. : The esophageal obturator airway. A review. JAMA 1983;250:1081–1084.CrossRefGoogle ScholarPubMed
19Wang, HE, Sweeney, TA, O'Connor, RE, Rubinstein H: Failed prehospital intubations: An analysis of emergency department courses and outcomes. Prehosp Emerg Care 2001;5:134–141.CrossRefGoogle ScholarPubMed
20Stewart, RD, Paris, PM, Winter, PM, et al. : Field endotracheal intubation by paramedical personnel: Success rates and complications. Chest 1984;85:341–345.CrossRefGoogle ScholarPubMed
21Atherton, GL, Johnson, JC: Ability of paramedics to use the Combitube in prehospital cardiac arrest. Ann Emerg Med 1993;22:1263–1268.CrossRefGoogle ScholarPubMed
22Vezina, D, Lessard, MR, Bussieres, J, et al. : Complications associated with the use of the Esophageal-Tracheal Combitube. Can J Anaesth 1998;45:76–80.CrossRefGoogle ScholarPubMed
23Stiell, IG: OPALS Study Phase III: What is the impact of advanced life support on out-of-hospital cardiac arrest? Acad Emerg Med 2003;10:423.CrossRefGoogle Scholar
24Kim, C., Fahrenbruch, CE, Cobb, LA, Eisenberg, MS: Out-of-hospital cardiac arrest in men and women. Circulation 2001;104(22):2699–2703.CrossRefGoogle ScholarPubMed
25De Maio, VJ, Stiell, IG, Spaite, DW, et al. : Ontario Prehospital Advanced Life Support (OPALS) Study Group: CPR-only survivors of out-of-hospital cardiac arrest: Implications for out-of-hospital care and cardiac arrest research methodology. Ann Emerg Med 2001;37:602–608.CrossRefGoogle Scholar
26Stiell, IG, Wells, GA, Field, BJ, et al. : Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA 1999;281:1175–1181.CrossRefGoogle ScholarPubMed
27Fairbanks, RJ, Shah, MN, Lerner, EB, et al. : Out-of-hospital cardiac arrest survival rates in an EMS system utilizing the system status management dispatch model. Acad Emerg Med 2003;10(5):444–445.CrossRefGoogle Scholar
28Dowie, R, Campbell, H, Donohoe, R, Clarke, P: “Event tree” analysis of outof-hospital cardiac arrest data: Confirming the importance of bystander CPR. Resuscitation 2003;56:173–181.CrossRefGoogle Scholar
29Robinson, JS, Davies, MK, Johns, BM, Edwards, SN: “Out-of-hospital cardiac arrests” treated by the West Midlands Ambulance Service over a 2-year period. Eur J Anaesthesiol 1998;15:702–709.CrossRefGoogle Scholar