What Is a Combitube®?

Andy Josiah

The Combitube® is a piece of medical equipment used for intubation of patients who have difficulty breathing as a result of cardiac or respiratory arrest. It is a common device in pre-hospital and emergency settings, with the standard device used on younger patients who are no taller than 5 feet and the Combitube® SA for people under 4 feet. The invention of a trio of Austrian researchers, the Combitube® is most commonly manufactured by health-care company Covidien through its Nellcor™ brand. It is also known as the Esophageal-Tracheal Combitube, named after the parts of the body through which the device is inserted.

A combitube will be used during intubation.
A combitube will be used during intubation.

The Combitube® is classified as a blind insertion airway device (BIAD). This means that the device needs to be accurately placed even without direct vision of placement. Therefore patients must have airways that are anatomically intact to avoid misplacement or injury.

Patients who are pregnant may experience difficulties during the intubation process.
Patients who are pregnant may experience difficulties during the intubation process.

This particular BIAD is designed as a double-lumen tube. This allows it to be inserted in the esophagus, the tube that permits content to pass to the stomach; or the trachea, which is better known as the windpipe. Another advantage of the Combitube® is its small size, thus making it optimally portable. Overall, the device is meant to open the patient's air passage for proper ventilation or to deliver oxygen.

Although the Combitube&reg SA was designed for smaller patients, it is incredibly rare compared to the regular version. Additionally, even with the flexibility of its tube, there is a slight chance of causing esophageal trauma, which can involve creating a hole in the organ. Such a laceration allows food and drink to pass from the esophagus into the mediastinum, the chest's surrounding area, consequently leading to an infection called mediastinitis that causes swelling and irritation. In some cases, emergency medical technicians (EMTs) have problems securing the Combitube® in the patient.

In 2007, a team of medical researchers from Université Laval in Quebec, Canada, published a report titled "Complications Associated with the Esophageal-Tracheal Combitube in the Pre-Hospital Setting." It was the result of a ten-year study (1993 to 2003) of EMTs in the Quebec City Health Region using the Combitube® as their major airway device for patients. The report concluded that this particular BIAD was the cause of serious complications that include esophageal trauma and mediastinitis, as well as upper airway bleeding. Such conclusions prevent the Combitube® from being a popular, widely used device beyond pre-hospital and emergency workplaces. One of the major alternatives to the Combitube® is the laryngeal mask airway (LMA), an invention by British anesthetist Archie Brain that enjoys far more popularity as an airway manager and elective anesthesia instrument.

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