ESOPHAGEAL TRACHEAL COMBITUBE

An esophageal tracheal combitube consists of a twin-lumen tube with a proximal
low-pressure cuff that seals the pharyngeal area, a distal cuff that seals the esophagus
(or the trachea), and ports for ventilation in-between .

The pharyngeal lumen and KING LT supraglottic airways have similar
function. It is available in two sizes only.

■ 37F: Small adult/large child
■ 41F: Larger adults

INDICATIONS
■ Apneic and unconscious adult with
■ Failed intubation
■ Limited mouth opening

CONTRAINDICATIONS
■ Patient with intact airway reflexes
■ Esophageal disease
■ Caustic ingestion
■ Upper airway obstruction
■ Children ≤4 feet tall

PROCEDURE
■ Grab and elevate the tongue and jaw with nondominant hand.
■ Pass the tube blindly into the pharynx until the marker on the tube is
between the patient’s teeth.
■ Placement is facilitated by neck flexion.

■ Inflate the pharyngeal balloon with 100 mL of air.
■ Inflate the distal white balloon with 5–15 mL of air.
■ Begin ventilation through the longer (blue) connector.
■ Air entry to lungs → confirms esophageal placement.
■ Air entry into stomach →tracheal placement (rare), in which case confirm
with ventilation through shorter (clear) tube.

The Combitube can be used in the setting of upper GI bleed,
but not if there is expected esophageal pathology.