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Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting

[Complications associées avec l’utilisation du Combitube dans la prise en charge des arrêts cardio-respiratoires en préhospitalier]

From the Département d’anesthésie-réanimation, Centre hospitalier affilié universitaire de Québec, Université Laval, Québec, Québec, Canada.

Address correspondence to: Dr. Claude A. Trépanier, Département d’anesthésie-réanimation, Hôpital de l’Enfant-Jésus du CHA, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada. Phone: 418-649-5807; Fax: 418-649-5918; E-mail: delalaitue{at}videotron.ca

Purpose: The Esophageal-Tracheal Combitube® (Combitube) is widely used for the management of the airway during cardiopulmonary resuscitation in the pre-hospital setting. Although serious complications have been reported with the Combitube, there is a paucity of data relative to the frequency and nature of such complications. The objective of this retrospective study was to determine the incidence and the nature of complications associated to the Combitube in the pre-hospital setting.

Methods: Since 1993, in the Quebec City Health Region, the basic life support treatment algorithm for emergency medical technicians has included the use of a Combitube as the primary airway device for management of all patients presenting with cardiac or respiratory arrest. The database of the emergency coordination services was searched for the period between 1993 and 2003 (2,981 patients). Only those patients who survived at least 12 hr were included. Medical records of these patients were reviewed to identify complications related to the use of the Combitube.

Results: Two-hundred-eighty (280) patients were identified. Fifty-eight (58) patients (20.7%, confidence interval (CI)95% = 16.0%–25.4%) presented 69 complications: aspiration pneumonitis (n = 31), pulmonary aspiration (n = 16), pneumothorax (n = 6), upper airway bleeding (n = 4), esophageal laceration (n = 3), sc emphysema (n = 2), esophageal perforation and mediastinitis (n = 2), tongue edema (n = 2), vocal cord injury (n = 1), tracheal injury (n = 1), and pneumomediastinum (n = 1). Thirteen of these complications (12 patients, 4.3%, CI_95% = 2.0%–6.3%) were judged as most likely resulting from trauma associated with insertion of the Combitube.

Conclusion: The use of the Combitube in the pre-hospital setting is associated with a notable incidence of serious complications.

This article has been cited by other articles:

				S. J. Vaida The Esophageal-Tracheal Combitube(R) and esophageal injuries Can J Anesth, June 1, 2007; 54(6): 491 - 492. [Full Text] [PDF]

				Complications Associated with the Combitube in the Prehospital Setting Journal Watch Emergency Medicine, March 2, 2007; 2007(302): 4 - 4. [Full Text]