Abstract
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%, CI95% = 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.
Résumé
Objectif
Le Esophageal-Tracheal Combitube® (Combitube) est couramment utilisé pour assurer le contrôle des voies aériennes lors de situations d’arrêt cardio-respiratoire en préhospitalier. Bien que des complications graves reliées à l’utilisation du Combitube aient été rapportées, leur incidence réelle est mal connue. L’objectif de cette étude rétrospective était d’estimer l’incidence et la nature des complications associées à l’utilisation du Combitube en préhospitalier.
Méthode
Depuis 1993, le protocole de prise en charge préhospitalière de l’Agence régionale de santé de Québec inclut l’insertion d’un Combitube par les techniciens ambulanciers pour le contrôle initial des voies aériennes des patients en arrêt cardiaque ou respiratoire. Une recherche dans le registre de la centrale de coordination des urgences a été faite et a permis d’identifier 2 981 patients pour la période de 1993 à 2003. Les patients ayant survécu au moins 12 h après leur arrivée à l’hôpital ont été inclut dans cette étude. Les dossiers médicaux de ces patients ont été étudiés afin d’identifier des complications associées à l’utilisation du Combitube.
Résultats
Deux-cent-quatre-vingts (280) patients ont été inclut. Cinquante-huit (58) patients (20,7 %, intervalle de confiance (IC)95 % = 16,0-25,4 %) ont présenté 69 complications: pneumonie d’aspiration (n = 31), aspiration bronchique (n = 16), pneumothorax (n = 6), saignement des voies aériennes supérieures (n = 4), lacérations œsophagiennes (n = 3), emphysème sc (n = 2), perforation œsophagienne et médiastinite (n = 2), œdème de la langue (n = 2), lésion aux cordes vocales (n = 1), lésion trachéale (n = 1), pneumomédiastin (n = 1). Treize de ces complications (12 patients, 4,3 % 4,3 %, IC95% = 2,0 % - 6,3 %) ont été jugées le plus probablement associées à l’insertion du Combitube.
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Funding: This study was supported by departmental funds only. The authors have no financial relationship that has an interest in the subject of this study.
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Vézina, MC., Trépanier, C.A., Nicole, P.C. et al. Complications associated with the Esophageal-Tracheal Combitube® in the pre-hospital setting. Can J Anesth 54, 124–128 (2007). https://doi.org/10.1007/BF03022008
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DOI: https://doi.org/10.1007/BF03022008