Conclusions 4 the “standard“ Combitube 4 safe and efficient 4 insertion under direct vision recommended 4 slow inflation of oropharyngeal balloon 4 inflation volume: height (cm) - 100 or weight (kg) - 5 è suitable for all patients in whom tracheal intubation has to be avoided intubation has to be avoided the 37 Fr Combitube SA is...
FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS. u Use of ETC in trauma pts. in whom orotracheal rapid sequence intubation failed u Flight nurses trained with ETC u 12 pts. had ETC, 10 included Blostein, Koestner, Hoak J Trauma 1998; 44: 534-537
FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS. u Successful in all patients u Definitive airway control in ED: orotracheal (7), tracheostomy (2), cricothyroidotomy (1) u 7 mandible fractures, 4 TBI, 2 fa- cial fractures, 1 hemopneumoth
u Bridge between BVM and endotracheal tube Paramedic -Main indication-
COMPLICATIONS ASSOCIATED WITH THE USE OF THE COMBITUBE u 1139 pts. CPR with ETC + SAED u 2 pts. transparietal lacerations of anterior wall of esophagus u Distal cuff inflated with 20 to 40 ml !!! Maximum 12 ! CPR; CPPV Vézina, Lessard, Bussières, et al. Can J Anaesth 1998; 45:76-80
USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS u 420 Emergency medical technicians + automatic external defibrillator (EMT-Ds) u Firefighters with BLS-D u 125-350 h course curriculum for EMTs u 18 h training with AED and Combitube u Assessment of location with EDD (syringe) + auscultation Lefrançois DP, Dufour DG Resuscitation 2002; 52:77-83
USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS u Montérégie / Quebec: 11,000 square km, population of 1.3 million u Successful placement in 725 out of 760 cardiac arrest patients (95.4 %) u Ventilation successful in 695 (91.4 %) pts. u Autopsy in 133 pts.: no esophageal lesions or injury to airway structures u EMT-Ds can use ETC safely + effectively
Merits of COMBITUBE u Low price, all-in-one device u Non invasive u No preparations necessary u Rapid and easy intubation u Immediate fixation u PREVENTION OF ASPIRATION u HIGH VENTILATORY PRESSURES u No power supply
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care American Heart Association JAMA 1992; 268:2203 2 / 2000: Class IIa DEVICE !!!
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice Guidelines for Management of the Difficult Airway. Anesthesiology 1993; 78:597-602
European Resus- citation Council Baskett PJF, Bossaert L, Carli P, Chamberlain D, Dick W, Nolan JP, Parr MJA, Scheidegger D, Zideman D: Guidelines for the advanced management of the airway and ventilation during resuscitation. Resuscitation 1996; 31:201-230
Conclusion COMBITUBE u Whenever endotracheal intubation not immediately possible u Short training time u Adequate ventilation
Combitube ® - Homepage: u http://www.combitube.org or or u http://www.combitube.net Webmaster: Roland Hofbauer