Airway management with endotracheal tube versus Combitube during parabolic flights.
BACKGROUND
Training of National Aeronautics and Space Administration space shuttle astronauts revealed difficult airway management with endotracheal tubes (ETTs) under microgravity conditions. The authors performed a randomized comparative study of ETT and Combitube (ETC; Tyco Healthcare, Pleasanton, CA). The aim of the study was to evaluate ease, time of insertion, and success rates during normogravity and parabolic flights using mannequins.


METHODS
After normogravity experiments, four flyers performed intubation on a mannequin during the flights. Sixty-two intubation attempts were performed using the ETC (normogravity, 29; microgravity, 33), and 58 intubation attempts were performed using the ETT (each 29 attempts, both conditions). Time to completion of the intubation procedure, success rate, and ease of insertion were recorded.


RESULTS
The ETC performed equally well between normogravity (median, 18 s; range, 17-25 s) and microgravity (median, 18.5 s; range, 17-28 s), whereas the ETT performed significantly slower under microgravity (median, 20 s; range, 17-27 s) as compared with normogravity (median, 18 s; range, 16-22 s; P = 0.019). One hundred nine of 120 (90%) were successful. The ETT and ETC were comparable with respect to successful intubations, under normogravity or microgravity, respectively.


CONCLUSIONS
Both the ETC and ETT perform comparably well. Slight differences could be found with respect to time of insertion in favor of the ETC. Because this is the first experiment using the ETC on the KC-135, it is shown that there is enough time to perform the insertion procedure. Because the ETC airway requires less training and is easier to insert than an ETT, it is recommended for further study as an alternative airway to what is currently on the shuttle.
Rabitsch
Werner
W
Department of Internal Medicine I, Intensive Care Unit, Medical University, Vienna, Austria.
Moser
Doris
D
Inzunza
Michelle R
MR
Niedermayr
Monika
M
Köstler
Wolfgang J
WJ
Staudinger
Thomas
T
Locker
Gottfried J
GJ
Schellongowski
Peter
P
Wulkersdorfer
Beatrix
B
Rich
James M
JM
Meyer
Brigitte
B
Benumof
Jonathan L
JL
Frass
Michael
M
D004581:Electronics; D004869:Equipment Safety; D006112:Gravitation; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D007858:Learning; D008348:Manikins; D018474:Weightlessness Simulation