What is a Combitube and How is it Used in Cases of Respiratory Arrest?

The esophageal tracheal Combitube is a medical device which serves as an alternative airway through which a health care provider can ventilate or "breath for" an apneic (non-breathing) patient. It is constructed of non-toxic PVC and latex and is technically a double lumen airway in which the two lumens or tubes are divided by a partition resulting in what can loosely be called two tubes in one larger tube. One of the tubes is known as the blue, esophageal or tube 1 while the other is the white, tracheal or tube 2. The Combitube also has two inflatable cuffs at its end, a large proximal one and a small distal cuff.

Why Is a Combitube Used?

Disease, some types of trauma (injury), and choking can all cause respiratory distress (difficulty breathing) which has the potential to lead to respiratory arrest or the complete cessation of breathing. Respiratory arrest is an invitation to the onset of cardiac arrest. A person who is in respiratory and cardiac arrest is dead, but he or she might be revived if rescue breathing and cardiopulomonary resuscitation is performed without delay--before the brain dies. The Combitube is one alternative airway used to ventilate a patient in respiratory arrest. Ventilation through the Combitube, while not as effective as through an endotracheal tube, is superior to rescue breathing using no airway adjunct at all or only a simple one. The tongue of a deeply unconscious patient in respiratory arrest can easily relax and obstruct the airway by falling back in to the pharynx (back of throat and nose). A simple oropharangeal or nasopharangeal airway can be used to combat this problem if there are no contraindications. Use of the Combitube takes care of such problems while providing superior ventilation. There are some contraindications for the use of the Combitube also, but they are few.

How Is the Combitube Used?

This alternative airway is primarily used by emergency medical technicians (EMT's) and paramedics who tend to be outside of a medical center or hospital when providing medical care. To see the Combitube used on someone would probably be somewhat of a frightening sight to laypeople. It isn't exactly a small device and is, in my opinion, somewhat invasive. I do, however, view it as an ingenious device although in some emergency medical systems (EMSs), it's taking a back seat to another alternative airway used to ventilate patients in respiratory arrest--the King LT.

The Combitube is lubricated with a water soluble lubricant and then placed into the mouth and gently advanced passed the throat into either the esophagus (tube leading to the stomach) or the trachea (wind pipe). The large pharyngeal cuff is inflated with 100 cc of air (85 cc if using the Combitube for small adults (SA)), and 15 cc inflates the small tracheal/esophageal cuff (12 cc for SA). I find this device to be an ingenious invention because it's used in what's known as a blind insertion unlike orotracheal intubation. The EMT or paramedic cannot see whether it enters the esophagus or the trachea, but this alternative airway is designed to allow life-saving ventilation of the patient in respiratory arrest whether it is advanced into the esophagus or the trachea. How can this be? Remember, the Combitube is like two tube in one. If ventilation is provided through the esophageal connector (the Combitube usually ends up in the esophagus), air is forced into the larynx (voice box) and trachea (wind pipe) because it passes through perforations in the esophageal tube. The perforations are between the large pharangeal cuff which seals the throat and the smaller esophageal/tracheal cuff which in such a case would seal the esophagus. Air has no where to go but into the trachea.

If, on the other hand, the Combitube goes into the trachea, the EMT or paramedic ventilates the patient in respiratory arrest through the tracheal connector which has an open end through which air can pass even more directly into the trachea. So, either way air goes into the trachea when this device is properly used. One of the biggest dangers with using this alternative airway would be failure on the part of the EMT or paramedic to auscultate (listen with a stethoscope) the patient's lungs to verify placement. Initially, ventilation is done through the esophagus, if no breath sounds are heard, the EMT or paramedic must quickly switch to ventilations through the tracheal tube.

Source:

My EMT training, experience