Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness.

The success of cardiopulmonary resuscitation after cardiac arrest depends not only on the duration of the arrest, but also on the prompt establishment of a patent airway. In this study, we tested the safety and promptness of intubation with esophageal tracheal combitube (ETC) when compared to conventional endotracheal airway. Effectiveness of ventilation via the ETC as shown by blood gas analyses appeared to be comparable to endotracheal airway. Data suggest that the ETC might serve as a useful device during cardiopulmonary resuscitation.

[The esophageal tracheal Combitube (ETC): animal experiment results with a new emergency tube]. / Esophageal Tracheal Combitube (ETC): Tierexperimentelle Ergebnisse mit einem neuen Notfalltubus.

Prompt and effective ventilation, essential for patients with cardiopulmonary arrest, may be provided by a new airway for emergency resuscitation. The "Esophageal Tracheal Combitube (ETC)" offers endotracheal or esophageal obturator ventilation according to choice. Ventilation is therefore always possible after blind intubation. Experimental studies in dogs showed encouraging results during oesophageal placement of the ETC; blood gas analyses and cardiovascular parameters, in particular, were comparable to conventional endotracheal ventilation. Satisfying results were achieved during routine surgical operations in humans. We intend to use the ETC as a device for emergency cardiopulmonary resuscitation in humans. It is especially suitable for medical personnel not trained in endotracheal intubation. The ETC has been conceived to bridge the gap of the prehospital phase.

The esophageal tracheal combitube: preliminary results with a new airway for CPR.

We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.

Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation.

Prompt establishment of an airway is a primary goal in CPR of nonbreathing and unconscious patients. The esophageal tracheal combitube (ETC) is a new airway, designed for emergency intubation providing sufficient ventilation whether the airway is placed into the trachea or into the esophagus. We evaluated the effectiveness of the ETC in 31 patients during CPR. Blood gas analyses obtained during esophageal placement of the ETC showed results comparable to those of ventilation with a conventional endotracheal airway (ETA). The ETC appeared to oxygenate and ventilate patients adequately without complications. The efficacy, safety, and ease of insertion ensure rapid airway control. It is concluded that the ETC provides a sufficient alternative to the ETA whenever ideal conditions or trained staff for endotracheal intubation are not immediately available.

Esophageal tracheal combitube, endotracheal airway, and mask: comparison of ventilatory pressure curves.

The esophageal tracheal Combitube (ETC) is a new airway especially designed for airway maintenance and ventilation in unconscious patients such as those requiring CPR. The ETC may be used as an esophageal obturator or an endotracheal airway. Previous studies yielded a significantly higher mean arterial oxygen tension (PaO2) during ventilation using an ETC in the esophageal position compared to a conventional endotracheal airway (ETA). To investigate this phenomenon, endotracheal and airway opening pressures were examined in 12 patients in randomized order during ventilation with an ETC in the esophageal position, with an ETA, and with a mask, respectively. In this study again the PaO2 was higher with ETC compared to ETA. The following differences in intratracheal pressure and flow could be found for ETC when compared to ETA: smaller rising pressure during inspiration, prolonged expiratory flow time, and formation of a small positive end expiratory pressure (PEEP). These factors may be responsible for the improved oxygen tension with ETC. Comparing mask to ETC ventilation, PaO2 did not differ; however, mean arterial carbon dioxide tension was higher during mask ventilation.

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

Mechanical 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.