The esophageal obturator airway. A review

Smith, J. P.

doi:10.1001/jama.250.8.1081

Cited by 11 publications

(6 citation statements)

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“…15 Like the ETC, the EOA was intended to be a low skill, blind insertion device, but if it was placed inadvertently in the trachea, it would suffocate the patient. 16 " 18 The ETC solved this limitation of the EOA by having a double lumen, and therefore, is a true fail-safe, blind insertion device. 3 Results were compared with an earlier study in San Diego County, where the EMT-Ds had a similar success rate (155/195 or 79%) as paramedics had in this study (70%) (j> = 0.087, OR = 1.58; 95% CI = 0.94-2.65).…”

Section: Discussionmentioning

confidence: 99%

Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway

Calkins

Miller

Langdorf

2006

Prehosp. Disaster med.

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Introduction:Previous studies have proven the success of the EsophagealTracheal Combitube (ETC) as a primary airway, but not as a rescue airway.Objective:The object of this study was to observe success and complication rates of paramedic placement of an ETC as a rescue airway, and to compare success rates with endotracheal tube (ETT) intubation. The primary outcome indicator was placement with successful ventilation. Complication rates, esophageal placement, and return of spontaneous circulation (ROSC) were secondary measures.Methods:A retrospective review of the records of patients who had ETC attempts by Emergency Medical Services (EMS) was conducted for a period of three years. Complications were defined a priori. The ETC is used primarily as rescue airway for a failed attempt at an endotracheal tube (ETT) intubation. A control group for ETT placements was drawn from the EMS quality assurance (QA) database for the same period.Results:Esophageal-Tracheal Combitube insertion was attempted on 162 patients, of which, 113 (70%) were successful, 46 (28%) failed, and the outcome of three (2%) was not recorded. Inability to place the ETC occurred in 29 (18%) patients, and accounted for 48% (22/46) of failures. The use of the ETC caused dental trauma in one patient, and one placement of the ETC was related to the onset of subcutaneous emphysema. Blood in the ETC from active upper gatrointestinal bleeding occurred in nine patients (6%), and four tubes (3%) became dislodged en route to the hospital. The a priori complication rate was 44/162 (27%). Inability to determine placement of the ETC due to emesis from both ports occurred in 21 cases. Combining these problems with the a priori complications, the overall rate was 40% (65/162). EsophagealTracheal Combitube location was noted in a subset of 90 charts, of which, 76 (84%) were esophageal, and 14 (16%) were tracheal. Thirteen of 126 (10%) patients in cardiac arrest had return of spontaneous circulation (ROSC) in the field after placement of the ETC. An ETT was attempted in 128 control patients, of which, 107 (84%) were successful, 21 (16%) failed (odds ratio (OR) for ETT vs. ETC = 2.1; 95% CI = 1.12–3.86).Conclusion:Despite a low ROSC rate, the complication and success rates of ETC are acceptable for a rescue airway device. Tracheal placement of the Combitube is uncommon, but requires fail-safe discrimination. Similar to previous reports, the success ratio for ETT was greater than for the ETC.

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Section: Discussionmentioning

confidence: 99%

Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway

Calkins

Miller

Langdorf

2006

Prehosp. Disaster med.

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“…The EOA is frequently used in the prehospital setting (Shea et al, 1985;Hammargren et al, 1985;Hoflehner et al, 1984), but its use and effectiveness have been criticized recently (Auerbach & Geehr, 1983;Smith et al, 1983). Many perceived EOA problems are due to poor mask fit (White, 1984), inadvertent tracheal intubation (Bryson et al, 1978) and esophageal or gastric rupture (Hoffman et al, 1983).…”

Section: Discussionmentioning

confidence: 99%

Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit.

Frass

Frenzer

Mayer

et al. 1987

Emergency Medicine Journal

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SUMMARYMechanical ventilation in critically ill patients is usually performed with the conventional endotracheal airway. The esophageal tracheal combitube (ETC) is a new device for cardiopulmonary resuscitation, conceived to bridge the gap between hospital and prehospital phases. The ETC may be used in esophageal and endotracheal positions. The authors report six patients who were ventilated with the ETC in the esophageal obturator position for 2-8 h after emergency ventilation. Blood gas data showed adequate ventilation with the ETC during the observation period. Data suggest that mechanical ventilation with the ETC is possible for several hours after cardiopulmonary resuscitation. This might be helpful during the initial post-arrest period, when replacement of the ETC by a conventional endotracheal airway might destabilize a vulnerable patient.

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“…It has fallen out of favor because of significant complications, including inadvertent tracheal intubation and esophageal trauma. 69,70 Other airway management devices include the Cuffed Oropharyngeal Airway (COPA, Mallinckrodt Inc., St. Louis, Missouri, USA), the Cobra Perilaryngeal Airway (Engineered Medical Systems, Inc., Indianapolis, Indiana, USA) and other single and multi-lumen airways such as the Pharyngeal Tracheal Lumen Airway (PTL). Descriptions of these devices in either in-hospital or prehospital application are limited.…”

Section: Bag Valve Mask Ventilation and Other Alternate Airway Technimentioning

confidence: 99%

Alternate Airways in the Prehospital Setting (Resource Document to NAEMSP Position Statement)

Guyette

Greenwood

Neubecker

et al. 2007

Prehospital Emergency Care

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The esophageal obturator airway. A review

Cited by 11 publications

References 0 publications

Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway

Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway

Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit.

Alternate Airways in the Prehospital Setting (Resource Document to NAEMSP Position Statement)

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