Successful prehospital airway management by EMT-Ds using the combitube.
OBJECTIVE
To evaluate the ability to train emergency medical technicians-defibrillation (EMT-Ds) to effectively use the Combitube for intubations in the prehospital environment.


METHODS
This was an 18-month prospective field study in which EMT-Ds were trained how and in what situations to use the Combitube. Data were then obtained for all patients in whom Combitube insertion was attempted. Indications for use of the Combitube included: unconsciousness without a purposeful response, absence of the gag reflex, apnea or respiratory rate less than 6 breaths/min, age more than 16 years, and height at least 5 feet tall. Contraindications were: obvious signs of death, intact gag reflex, inability to advance the device due to resistance, or known esophageal pathology. Data were entered prospectively from the San Diego County EMS QANet database for prehospital providers.


RESULTS
Twenty-two EMT-D provider agencies, involving approximately 500 EMT-Ds, were included as study participants. Combitube insertions were attempted in 195 prehospital patients in cardiorespiratory arrest, with appropriate indication for Combitube use. An overall successful intubation rate (defined as the ability to successfully ventilate) of 79% was observed. Identical success rates for medical and trauma patients were noted. The device was placed in the esophagus 91% of the time. Resistance during insertion was the major reason for unsuccessful Combitube intubations. An overall hospital admission rate of 19% was observed. No complications were reported.


CONCLUSIONS
EMT-Ds can be trained to use the Combitube as a means of establishing an airway in the prehospital setting. Future studies will need to further evaluate its effect on patient outcome.
Ochs
M
M
San Diego County Department of Health Services, University of California, San Diego Medical Center, 92103, USA.
Vilke
G M
GM
Chan
T C
TC
Moats
T
T
Buchanan
J
J
D002140:California; D002983:Clinical Competence; D002985:Clinical Protocols; D000075202:Contraindications; D004634:Emergency Medical Technicians / Q000193:education* / Q000592:standards; D006801:Humans; D007318:Inservice Training; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012449:Safety; D017211:Treatment Failure