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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: milangdo@uci.edu
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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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