open access

Vol 3, No 2 (2018)
Research paper
Published online: 2018-09-27
Get Citation

Securing the airway patency by firefighters with the use of CombiTube. A pilot data

Michael Frass, Oliver Robak, Jacek Smereka, Agata Dabrowska, Marek Dabrowski, Michael Czekajlo, Wladyslaw Gawel, Lukasz Szarpak
DOI: 10.5603/DEMJ.2018.0011
·
Disaster Emerg Med J 2018;3(2):46-50.

open access

Vol 3, No 2 (2018)
ORIGINAL ARTICLES
Published online: 2018-09-27

Abstract

INTRODUCTION: The protection of the airways with the use of vomer devices for ventilation is one of the elements of the procedure in cardiopulmonary resuscitation. One of the alternative ways to protect the airways from endotracheal intubation is the CombiTube tube. The aim of the study was to assess the ability to protect airway patency using CombiTube during simulated cardiopulmonary resuscitation performed by firefighters.

METHOD: This study was a prospective randomized crossover simulation study. The study included 56 firefighters who performed airway patency protection with the use of CombiTube during simulated cardiopulmonary resuscitation with and without chest compressions.

RESULTS: The median duration of securing airway patency with CombiTube device during scenario without and with chest compressions was: 21 s (IQR; 14−25.5) vs. 21.5 s (IQR; 15−27), respectively. The vast majority of attempts to insert CombiTube resulted in the insertion of the device to the esophagus: 92.8% vs. 91.1% (with and without chest compressions, respectively). The insertion of CombiTube to the trachea was observed in 7.1% vs. 8.9% during scenarios with and without chest compression, respectively. Study participants assessed the easiness of performing the procedure at 19 points (IQR, 13−22) for scenario without chest compression, and 18.5 points (IQR, 14−21.5) for scenario with uninterrupted chest compressions.

CONCLUSIONS: Firefighters are able to secure the airway patency with the use of CombiTube tube after a short training. Compressing the chest during resuscitation does not prolong the procedure of maintaining the airway patency with CombiTube. The tip of the CombiTube tube is inserted into the esophagus in over 91% of cases.

Abstract

INTRODUCTION: The protection of the airways with the use of vomer devices for ventilation is one of the elements of the procedure in cardiopulmonary resuscitation. One of the alternative ways to protect the airways from endotracheal intubation is the CombiTube tube. The aim of the study was to assess the ability to protect airway patency using CombiTube during simulated cardiopulmonary resuscitation performed by firefighters.

METHOD: This study was a prospective randomized crossover simulation study. The study included 56 firefighters who performed airway patency protection with the use of CombiTube during simulated cardiopulmonary resuscitation with and without chest compressions.

RESULTS: The median duration of securing airway patency with CombiTube device during scenario without and with chest compressions was: 21 s (IQR; 14−25.5) vs. 21.5 s (IQR; 15−27), respectively. The vast majority of attempts to insert CombiTube resulted in the insertion of the device to the esophagus: 92.8% vs. 91.1% (with and without chest compressions, respectively). The insertion of CombiTube to the trachea was observed in 7.1% vs. 8.9% during scenarios with and without chest compression, respectively. Study participants assessed the easiness of performing the procedure at 19 points (IQR, 13−22) for scenario without chest compression, and 18.5 points (IQR, 14−21.5) for scenario with uninterrupted chest compressions.

CONCLUSIONS: Firefighters are able to secure the airway patency with the use of CombiTube tube after a short training. Compressing the chest during resuscitation does not prolong the procedure of maintaining the airway patency with CombiTube. The tip of the CombiTube tube is inserted into the esophagus in over 91% of cases.

Get Citation

Keywords

airway management; firefighter; prehospital; cardiopulmonary resuscitation; medical simulation

About this article
Title

Securing the airway patency by firefighters with the use of CombiTube. A pilot data

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 3, No 2 (2018)

Article type

Research paper

Pages

46-50

Published online

2018-09-27

DOI

10.5603/DEMJ.2018.0011

Bibliographic record

Disaster Emerg Med J 2018;3(2):46-50.

Keywords

airway management
firefighter
prehospital
cardiopulmonary resuscitation
medical simulation

Authors

Michael Frass
Oliver Robak
Jacek Smereka
Agata Dabrowska
Marek Dabrowski
Michael Czekajlo
Wladyslaw Gawel
Lukasz Szarpak

References (24)
  1. Qureshi MJ, Kumar M. Laryngeal mask airway versus bag-mask ventilation or endotracheal intubation for neonatal resuscitation. Cochrane Database Syst Rev. 2018; 3: CD003314.
  2. Moors XRJ, Rijs K, Den Hartog D, et al. Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it has added value compared to regular emergency medical service? Eur J Trauma Emerg Surg. 2018; 44(3): 407–410.
  3. Kurowski A, Szarpak L, Zasko P, et al. Comparison of direct intubation and Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T.) for endotracheal intubation during cardiopulmonary resuscitation. Randomized manikin study. Anaesthesiol Intensive Ther. 2015; 47(3): 195–199.
  4. Benoit JL, Gerecht RB, Steuerwald MT, et al. Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation. 2015; 93: 20–26.
  5. Kleinman ME, Goldberger ZD, Rea T, et al. 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018; 137(1): e7–ee13.
  6. Gaitini LA, Vaida SJ, Agro F. The Esophageal-Tracheal Combitube. Anesthesiol Clin North America. 2002; 20(4): 893–906.
  7. An J, Nam SB, Lee JS, et al. Comparison of the i-gel and other supraglottic airways in adult manikin studies: Systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(1): e5801.
  8. Choi YJi, Park S, Chi SI, et al. Combitube insertion in the situation of acute airway obstruction after extubation in patients underwent two-jaw surgery. J Dent Anesth Pain Med. 2015; 15(4): 235–239.
  9. Smereka J, Czyzewski L, Szarpak L, et al. Comparison between the TrueView EVO2 PCD and direct laryngoscopy for endotracheal intubation performed by paramedics: Preliminary data. Am J Emerg Med. 2017; 35(5): 789–790.
  10. Ladny JR, Bielski K, Szarpak L, et al. Are nurses able to perform blind intubation? Randomized comparison of I-gel and laryngeal mask airway. Am J Emerg Med. 2017; 35(5): 786–787.
  11. Ladny JR, Sierzantowicz R, Kedziora J, et al. Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation. Am J Emerg Med. 2017; 35(3): 518–519.
  12. Aleksandrowicz S, Czyzewski L, Smereka J, et al. Tracheal intubation with a Macintosh laryngoscope with and without chest compressions, performed by nurses. Am J Emerg Med. 2016; 34(12): 2448–2449.
  13. Sethi AK, Desai M, Tyagi A, et al. Comparison of combitube, easy tube and tracheal tube for general anesthesia. J Anaesthesiol Clin Pharmacol. 2014; 30(4): 526–532.
  14. Saeedi M, Hajiseyedjavadi H, Seyedhosseini J, et al. Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study. Int J Crit Illn Inj Sci. 2014; 4(4): 303–308.
  15. Atherton GL, Johnson JC. Ability of paramedics to use the Combitube in prehospital cardiac arrest. Ann Emerg Med. 1993; 22(8): 1263–1268.
  16. Calkins TR, Miller K, Langdorf MI. Success and complication rates with prehospital placement of an esophageal-tracheal combitube as a rescue airway. Prehosp Disaster Med. 2006; 21(2): 97–100.
  17. Szarpak L, Karczewska K, Czyzewski L, et al. Airtraq Laryngoscope Versus the Conventional Macintosh Laryngoscope During Pediatric Intubation Performed by Nurses: A Randomized Crossover Manikin Study With Three Airway Scenarios. Pediatr Emerg Care. 2017; 33(11): 735–739.
  18. Truszewski Z, Czyzewski L, Smereka J, et al. Ability of paramedics to perform endotracheal intubation during continuous chest compressions: a randomized cadaver study comparing Pentax AWS and Macintosh laryngoscopes. Am J Emerg Med. 2016; 34(9): 1835–1839.
  19. Enlund M, Miregard M, Wennmalm K. The Combitube for failed intubation--instructions for use. Acta Anaesthesiol Scand. 2001; 45(1): 127–128.
  20. Mercer M. The role of the Combitube in airway management. Anaesthesia. 2000; 55(4): 394–395.
  21. Rumball CJ, MacDonald D. The PTL, Combitube, laryngeal mask, and oral airway: a randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care. 1997; 1(1): 1–10.
  22. Bollig G. Combitube and Easytube should be included in the Scandinavian guidelines for pre-hospital airway management. Acta Anaesthesiol Scand. 2009; 53(1): 139–140.
  23. Rabitsch W, Schellongowski P, Staudinger T, et al. Comparison of a conventional tracheal airway with the Combitube in an urban emergency medical services system run by physicians. Resuscitation. 2003; 57(1): 27–32.
  24. Zamora JE, Saha TK. Combitube rescue for Cesarean delivery followed by ninth and twelfth cranial nerve dysfunction. Can J Anaesth. 2008; 55(11): 779–784.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl