The Esophageal-Tracheal Combitube (ETC; Kendall Sheridan, Mansfield, MA) and the EasyTube (EzT; Teflex Medical [Ruesch], Kernen, Germany) are double lumen airway devices that can be blindly inserted into the unconscious and unresponsive patient. The ETC and EzT function to adequately ventilate and oxygenate a patient while simultaneously protecting the airway from aspiration.1,2 They are 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 airway device when standard orotracheal intubation fails.3–5 These are the only two double lumen devices used in the prehospital setting and the Emergency Department. The Emergency Physician should be familiar with these devices so that it can be removed and exchanged with an endotracheal tube if placed in the prehospital environment or if required in the Emergency Department to manage a difficult airway.
The ETC is a double-tube, double lumen, and double-cuffed device (Figure 20-1). The ETC starts as two distinct tubes that fuse into one, but remain functionally separated by a partition. The shorter clear tube is continuous with the distal open port, also known as the tracheoesophageal lumen. At its distal end is the distal tracheoesophageal cuff, similar to that of an endotracheal tube. It is a high-volume, low-pressure balloon that is inflated through the white inflation port. The longer blue tube is continuous with the eight perforations known as the proximal ports. A large pharyngeal cuff is just proximal to the perforations. This cuff is positioned between the base of the tongue and the palate, separating the oral and nasal cavities from the remainder of the airway. It is inflated through the blue inflation port.
The Combitube. A. Photograph. B. Illustration.
The EzT is also a double-tube, double lumen, and double-cuffed device with a structure similar to the ETC (Figure 20-2). However, it has several differences in comparison to the ETC. First, the shorter clear tube ends as a conventional single lumen 7.5 mm endotracheal tube. Second, the longer blue tube ends in an open aperture, rather than multiple perforations. Third, the EzT is latex free.6
The EasyTube. A. Photograph. B. Illustration.
Both the ETC and EzT may be inserted blindly into a patient's airway. If the distal tip enters the trachea, the patient is ventilated through the shorter clear 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 blue tube, whose proximal ports lie in the hypopharynx, while the distal cuff will occlude the esophagus.