Failed rapid sequence intubation in trauma patients: esophageal tracheal combitube is a useful adjunct.
OBJECTIVE
To characterize the use of the esophageal tracheal combitube (ETC) in trauma patients who fail orotracheal rapid sequence intubation (RSI).


METHODS
Prospective protocol design and retrospective chart review.


METHODS
Flight nurses were trained in the use of the ETC by mannequin simulation, videotape review, and didactic sessions. ETC insertion was attempted after failure of two or more attempts at orotracheal RSI. Over a 12-month period, 12 patients had ETC insertion, and 10 cases qualified for review. Injuries, number of failed orotracheal RSI attempts, definitive airway, initial arterial blood gas results, and outcome were recorded.


RESULTS
ETC insertion was successful in all 10 patients in whom it was attempted. Definitive airway control was achieved by conversion to orotracheal intubation in seven patients, emergency department cricothyroidotomy in one patient, and operative room tracheostomy in two patients. No patient died because of failure to control the airway. Seven patients requiring ETC had mandible fractures.


CONCLUSIONS
ETC insertion is an effective method of airway control in trauma patients who fail orotracheal RSI. It may be particularly useful in the patient with maxillofacial trauma and offers a practical alternative to surgical cricothyroidotomy in difficult airway situations.
Blostein
P A
PA
Trauma Surgery Service, Bronson Medical Hospital, and West Michigan AirCare, Kalamazoo 49007, USA.
Koestner
A J
AJ
Hoak
S
S
D000293:Adolescent; D000328:Adult; D017732:Air Ambulances; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D016529:Emergency Nursing / Q000193:education; D004638:Emergency Treatment / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation*; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D011446:Prospective Studies; D012189:Retrospective Studies