The Esophageal-Tracheal Combitube (ETC; Kendall Sheridan, Mansfield,
MA) is a double-lumen airway device that can be blindly inserted
into the unconscious and unresponsive patient. An ETC functions
to adequately ventilate and oxygenate a patient while simultaneously
protecting the airway from aspiration.1,2 It is most often
used in the prehospital setting by emergency medical technicians
not trained in standard orotracheal intubation and by paramedic-level
rescuers as an alternative when standard orotracheal intubation
The ETC is a double-tubed, double-lumen, double-cuffed device
(Figure 9-1). The ETC starts as two distinct tubes that fuse into
one but remain functionally separated by a partition. The shorter-lumen
tube is continuous with the distal open port, also known as the
tracheoesophageal lumen. The longer-lumen tube is continuous with
the eight perforations known as the proximal ports. The distal tracheoesophageal
cuff is similar to that of an endotracheal tube. It is a high-volume,
low-pressure balloon. A large proximal pharyngeal cuff is designed
to be positioned between the base of the tongue and the palate.
Upon inflation, it separates the oral and nasal cavities from the remainder
of the airway. The longer tube, proximal cuff inflation port, and
the proximal (pharyngeal) cuff are color-coded blue. The shorter
tube, distal tracheoesophageal cuff, and its inflation port are
clear in color.
Anatomy of the Esophageal-Tracheal Combitube.
The ETC is inserted blindly into a patient’s airway.
If the distal tip enters the trachea, the patient is ventilated
through the shorter tube and the distal cuff prevents aspiration
of gastric contents into the trachea. If the distal tip enters the
esophagus, the patient is ventilated through the longer tube, whose
proximal ports lie in the hypopharynx, while the distal cuff will
occlude the esophagus.
The ETC is available in two sizes. The 37F SA model is meant
for small adults. The manufacturer recommends its use in patients
with a height of 122 to 168 cm (4 to 5.5 ft). The 41F model is meant
for larger adults with a height of 152 cm (5 ft) and greater. Patients
in the intermediate range of 152 to 168 cm (5 to 5.5 ft) can use
either model. A recent study demonstrated that the 37F SA model
can be used in patients up to 183 cm (6 ft, 1 in) in height.
Several advantages of the ETC contribute to its usefulness in
the acute situation. The ETC is effective as either a primary or
backup airway management device. A patient can be ventilated with
the tip in the esophageal or tracheal position. Minimal training
is necessary to use the ETC. There is no need for a laryngoscope
during the placement of the ETC. These attributes, and the fact
that the tube is easily inserted with neutral head and neck positioning,
make it suitable for rescuers of ...