[trakstar]

Opinions on combitubes? Anyone had any experience with them? Like it or Dislike it? and versus a LMA. I'd love a nice stimulating discussion. Thanks

[jwk]

Originally Posted by trakstar

Opinions on combitubes? Anyone had any experience with them? Like it or Dislike it? and versus a LMA. I'd love a nice stimulating discussion. Thanks

Emergency or pre-hospital device only in my book. Wouldn't use it for any kind of routine case.

[futuregasman]

My acls instructer says he keeps one in his car for a sure fire save when first on a seen. But I would not use one unless I had no other choice!

[gaspassah]

i suppose if it was handy and you were deep into the difficult airway algorhythm it would be useful. other than that, don't see a need or use in the OR
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[jwk]

Originally Posted by futuregasman

My acls instructer says he keeps one in his car for a sure fire save when first on a seen. But I would not use one unless I had no other choice!

I'm old enough to remember the old EOA's (esophageal obturator airways). The tube was much more rigid, and one reason they were eventually abandoned was because of a fairly significant incidence of esophageal perforation. Combitubes don't seem to be much different, except the tube isn't quite as rigid.

[snowfreeze]

I agree, the old EOAs were not good. I preferred to have someone do a few chest or abdominal compressions to have bubbles to follow instead of just a blind nothing. Sometimes a digital intubation works quite nice too.
From past experience, obese no necks, digital intubations are more likely to be successful, and skinny no necks, compressions and bubble follow works best.
A few times bending the wire at a 45 angle then just fishing worked too, but I did this in the field and sometimes under a car or hanging through a window. So do what you have to do.
Oh yeh I am an RN with pre-hospital RN status and lots of pre-hospital experience as a medic. 16 years all together.
I did have to do a stint in the OR for paramedic status and I had to do a minimum of successful tubes in the OR or on scene quartly for PHRN status. Some of these tricks are true to the OR also occasionally but usually...the position and the meds make it easier. If you don't get the tube in quickly and your patient is still under, just bag them and take a deep breath and relax. You will get them intubated or call some one else to do it. You have emergency trach option. Don't do the old combitube thing, it dosen't work. Combitube was a "dead is dead" but family is watching option....trust me, that is all I ever used it for.

[keermie]

The combitube is appealing because of ease, but can be cumbersome. A much better alternative which follows a lot of the same principles of the combitube is the King LT. The similarity is that there are 2 cuffs. You intubate the esophagus blind, which the device is designed to do, and inflate one pilot which inflates an esophageal and a post. pharynx balloons. The difference is that it has an opening anteriorly which makes it easy to intubate through the cords using a pedi bronchoscope, Cook, Eschman, . . . It is important to either rotate the ETT or use a Parker ETT, so that you do not cause damage to the cords while passing. Check em out.