Reinhard Frenzer

The esophageal tracheal combitube: Preliminary results with a new airway for CPR

We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.

Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation.

Prompt establishment of an airway is a primary goal in CPR of nonbreathing and unconscious patients. The esophageal tracheal combitube (ETC) is a new airway, designed for emergency intubation providing sufficient ventilation whether the airway is placed into the trachea or into the esophagus. We evaluated the effectiveness of the ETC in 31 patients during CPR. Blood gas analyses obtained during esophageal placement of the ETC showed results comparable to those of ventilation with a conventional endotracheal airway (ETA). The ETC appeared to oxygenate and ventilate patients adequately without complications. The efficacy, safety, and ease of insertion ensure rapid airway control. It is concluded that the ETC provides a sufficient alternative to the ETA whenever ideal conditions or trained staff for endotracheal intubation are not immediately available.

Ultrasound contact medium dispenser

The coupling agent dispenser serves to guide and, at the same, possibly to warm up the coupling agent, which is required for many medical examinations, directly during the examination from a reservoir to a diagnostic probe.

Esophageal tracheal combitube, endotracheal airway, and mask: comparison of ventilatory pressure curves.

The esophageal tracheal Combitube (ETC) is a new airway especially designed for airway maintenance and ventilation in unconscious patients such as those requiring CPR. The ETC may be used as an esophageal obturator or an endotracheal airway. Previous studies yielded a significantly higher mean arterial oxygen tension (PaO2) during ventilation using an ETC in the esophageal position compared to a conventional endotracheal airway (ETA). To investigate this phenomenon, endotracheal and airway opening pressures were examined in 12 patients in randomized order during ventilation with an ETC in the esophageal position, with an ETA, and with a mask, respectively. In this study again the PaO2 was higher with ETC compared to ETA. The following differences in intratracheal pressure and flow could be found for ETC when compared to ETA: smaller rising pressure during inspiration, prolonged expiratory flow time, and formation of a small positive end expiratory pressure (PEEP). These factors may be responsible for the improved oxygen tension with ETC. Comparing mask to ETC ventilation, PaO2 did not differ; however, mean arterial carbon dioxide tension was higher during mask ventilation.

Ventilation via the esophageal tracheal combitube in a case of difficult intubation.

U NEXPECTED DIFFICULTIES or inability to intubate the trachea may arise during emergency intubation even by trained personnel. A new airway has been designed for cardiopulmonary resuscitation that can be used either as an esophageal obturator or endotracheal tube.‘g2 The Esophageal Tracheal Combitube (ETC) combines the functions of an esophageal obturator airway (EOA)3-7 and a conventional endotracheal tube (Fig 1) (Sheridan Catheter Corp, Argyle, NY). The ETC is a twin-lumen tube. One lumen acts as an EOA. It has perforations at the pharyngeal site of the ETC and a blind distal end. Therefore, esophageal contents cannot regurgitate via the perforations into the trachea. The second lumen has a distal open end. At the distal site, the ETC is surrounded by a conventional cuff. At the proximal portion, a special pharyngeal balloon is positioned. At the oral end, the two lumens are linked via short tubes with connectors. The ETC can be inserted without use of a laryngoscope. The ETC is in the correct position when the two printed rings lie between the teeth or between the alveolar ridges in toothless patients. Then, after inflation with 100 mL of air, the pharyngeal balloon occupies the space between the root of the tongue and soft palate, by pushing the latter in a dorsocranial direction, and seals the oral and nasal cavities. Subsequently, the distal cuff is inflated, sealing either the esophagus or trachea. In most cases of blind insertion the ETC goes into the esophageal position, and the patient is ventilated via the “esophageal” lumen. The gases exit via the perforations into the hypopharynx and from there into the trachea. Auscultation of breath sounds and the absence of gastric insufflation ascertain correct esophageal positioning. Absence of adequate ventilation via lumen no. 1 means that the ETC probably entered the trachea. Ventilation by lumen no. 2 should lead to adequate bilateral breath sounds. The case presented demonstrates prolonged ventilation in both the operating room and intensive care unit via the ETC after unsuccessful attempts to intubate the trachea with a conventional endotracheal tube.

Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia

ZusammenfassungFragestellungEvaluation auf Sicherheit und Verlässlichkeit und Wirksamkeit des Combitube (Tyco Healthcare, Brunn am Gebirge, Österreich) während Allgemeinanästhesie.Patienten und Methoden250 Patienten, die eine Allgemeinanästhesie erhielten, wurden in die Studie eingeschlossen. Die verschiedenen Operationstypen, die Dauer der Operationen, Leichtigkeit der Einführung, und potentielle Komplikationen wurden registriert. Zudem wurden maximale Beatmungsdrücke und das Ausmaß der Leckage ermittelt.ErgebnisseDie Dauer der Operationen variierte zwischen 20 und 410 Minuten. Mehr als 96% der blinden Combitube Einführungen waren beim ersten Versuch nach einer durchschnittlichen Zeit von 18±5 Sekunden (12 bis 24 Sekunden) erfolgreich. Bei 99% der Patienten war es möglich, eine adäquate Oxygenation und Ventilation aufrecht zu erhalten. Alle Patienten waren während der Gesamtdauer der Operationen hämodynamisch stabil, mit einer pulsoximetrisch gemessenenen Sauerstoffsättigung von 97±2%. Der end-tidal gemessene Kohlendioxid-Partialdruck war 38±6 mm Hg. Die Leckage betrug auch bei Beatmungsdrücken von bis zu 40 cm H2O nicht mehr als 5%. Bei 18 Patienten (7,2%) fanden sich oberflächliche Schleimhaut-Lazerationen ohne anhaltende Folgeschäden. Es wurden keine schwerwiegenden Komplikationen während der Studie beobachtet.ZusammenfassungDie Beatmung via Combitube während Allgemeinanästhesie erscheint sicher und effektiv. Der Einsatz des Combitube sollte jedoch in Hinblick auf einen zukünftigen Notfalleinsatz bei elektiven Eingriffen trainiert werden.SummaryObjectivesEvaluation of safety and effectiveness of the Combitube during general anaesthesia.Patients and methods250 patients undergoing general anaesthesia were enrolled in the study. The respective types and duration of surgery, ease of insertion of the Combitube, and potential complications were recorded. Maximum ventilatory pressures and leak fraction were also evaluated in this study.ResultsDuration of surgery varied between 20 and 410 min. More than 96% of the blind Combitube insertions were successful at the first attempt, with a mean time of less than 18±5 seconds (range 12–24 seconds). In 99% of patients the Combitube worked well, and adequate oxygenation and ventilation was possible. All patients were haemodynamically stable during the entire duration of surgery. In all patients, pulse oximetry showed an oxygen saturation of 97±2% and an end-tidal carbon dioxide of 38±6 mm Hg. Leak fraction, calculated as a fraction of the inspired volume, did not increase to more than 5% up to a ventilation pressure of 40 cm H2O. Superficial laceration occurred in 18 patients (7.2%) without further sequelae. No severe injuries were observed during the study period.ConclusionVentilation via the Combitube appears to be safe and effective during general anaesthesia. Practice in elective cases is a requirement for successful use in an emergency situation.