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Chapter 9

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 fails.3–5

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.

FIGURE 9-1

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 ...

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