Combitube

Combitube

The Combitube, also referred to as the double-lumen airway, is a blind insertion airway device (BIAD) commonly employed in the pre-hospital emergency setting. Its purpose is to facilitate the tracheal intubation of a patient experiencing respiratory distress. This device comprises a cuffed, double-lumen tube inserted into the patient's airway to aid ventilation. Inflating the cuff allows the device to function similarly to an endotracheal tube, typically occluding the esophagus, thereby enabling ventilation and preventing pulmonary aspiration of gastric contents. It is offered in two sizes: 37 Fr (for patients 4 to 6 ft or 122 to 183 cm tall) and 41 Fr (for patients over 5 ft or 152 cm tall).

The primary advantage of the Combitube over endotracheal intubation is its simplicity of placement. Unlike traditional endotracheal tube insertion, which requires visual confirmation of placement in the trachea, the dual-lumen design of the Combitube allows ventilation to proceed regardless of esophageal or tracheal placement. Generally, the tube enters the esophagus, and ventilation occurs through tube number one. In the rare event that the Combitube is placed in the trachea, ventilation occurs through tube number two while tube number one is clamped. To confirm proper placement and rule out tracheal intubation, a device known as the Positube, which detects esophageal intubation, can be utilized on tube number two. The Positube assesses air flow resistance in tube number two and is particularly useful in noisy environments to verify correct Combitube placement during intubation.

The ease of use of the Combitube makes it suitable for use in the pre-hospital emergency setting, where advanced level providers capable of performing endotracheal intubation may not be immediately available. However, drawbacks of Combitube use include the inability to perform deep (subglottic) suctioning assuming esophageal placement.

While suggested as an option by organizations such as the American Heart Association and European Resuscitation Council, the Combitube is rarely utilized outside of the pre-hospital emergency setting due to its limited capability for long-term airway control. Alternatives to the Combitube include the laryngeal mask airway (LMA), endotracheal tube, and other BIADs such as the King Airway.