The Combitube, also known as the double-lumen airway, is a blind insertion airway device (BIAD) used in the pre-hospital and emergency setting. It is designed to provide an airway to facilitate the mechanical ventilation of a patient in respiratory distress.
Description and use
It consists of a cuffed, double-lumen tube that is inserted through the patients mouth to secure an airway and enable ventilation. Generally, the distal tube (tube one) enters the esophagus, where the cuff is inflated and ventilation is provided through the proximal tube (tube two) which opens at the level of the larynx. In the rare instance where the distal tube intubates the trachea, ventilation is provided through the distal tube while the proximal tube is clamped. 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. It is available in two sizes: 37 Fr (for patients 4 to 6 ft or 122 to 183 cm tall) and 41 Fr (for patients more than 5 ft or 152 cm tall).
The simplicity of placement is the main advantage of the Combitube over endotracheal intubation. 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 environment's.
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 facial nerve dysfunction associated with their use.
While it has been suggested as an option by the American Heart Association and European Resuscitation Council for situations where intubation attempts are unsuccessful since the year 2000, 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, and the laryngeal tube.
- Carin A. Hagberg, Tigran N. Vartazarian, Jacques E. Chelly, Andranik Ovassapian, "The incidence of gastroesophageal reflux and tracheal aspiration detected with pH electrodes is similar with the Laryngeal Mask Airway and Esophageal Tracheal Combitube — a pilot study" Canadian Journal of Anesthesia March 2004, Volume 51, Issue 3, pp 243-249
- Frass, Michael (1 January 2001). "Combitube". The Internet Journal of Emergency and Intensive Care Medicine 5 (2). doi:10.5580/14e7.
- Marie-Claude Vézina , Pierre C. Nicole , Claude A. Trépanier , Martin R. Lessard, "Retrospective study of complications associated with the Combitube", Canadian Journal of Anesthesia June 2005, Volume 52, Issue 1 Supplement, p A125
- 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
Ron Walls, Michael Murphy, Extraglottic devices, Manual of Emergency Airway Management, Lippincott Williams & Wilkins, 05.11.2012.