The esophageal tracheal combitube: preliminary results with a new airway for CPR.

We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.

[The esophageal tracheal Combitube (ETC): animal experiment results with a new emergency tube]. / Esophageal Tracheal Combitube (ETC): Tierexperimentelle Ergebnisse mit einem neuen Notfalltubus.

Prompt and effective ventilation, essential for patients with cardiopulmonary arrest, may be provided by a new airway for emergency resuscitation. The "Esophageal Tracheal Combitube (ETC)" offers endotracheal or esophageal obturator ventilation according to choice. Ventilation is therefore always possible after blind intubation. Experimental studies in dogs showed encouraging results during oesophageal placement of the ETC; blood gas analyses and cardiovascular parameters, in particular, were comparable to conventional endotracheal ventilation. Satisfying results were achieved during routine surgical operations in humans. We intend to use the ETC as a device for emergency cardiopulmonary resuscitation in humans. It is especially suitable for medical personnel not trained in endotracheal intubation. The ETC has been conceived to bridge the gap of the prehospital phase.

[Esophageal obturator tube, a new method for emergency artificial respiration]. / Der Osophagusverschlusstubus, eine neue Methode zur Notfallbeatmung.

Since several years, there are reports from the USA about the esophageal obturator airway, a simple device for emergency ventilatory support in the unconscious patient. The simplicity of its use is of advantage and may easily be achieved by paramedics too (blind insertion into the esophagus without the need of a laryngoscope). The occlusion of the esophagus prevents gastric inflation as well as regurgitation, emesis and aspiration. In our studies in anesthetized patients, the device proved to be effective. Still, preference should be given to endotracheal intubation whenever feasible. Several modifications of the EOA are discussed as well as possible complications.

[Gestational trophoblastic emboli as possible cause of an acute respiratory distress syndrome (author's transl)]. / Gestationsbedingte Trophoblastembolisation als mögliche Ursache einer kardiorespiratorischen Notfallsituation.

In a patient with gestational trophoblastic disease midtrimester abortion was induced by intravenous application of prostaglandin F2 alpha. After evacuation of the uterus the patient developed a severe acute respiratory distress syndrome (ARDS). This syndrome has been described as resulting from trophoblastic emboli, hemorrhage shock, gestational osmotic imbalance or disseminated intravascular coagulation. Also an indirect side effect of prostaglandin has to be discussed. Patients who develop acute pulmonary complications after evacuation of a molar pregnancy appear to be at extremely high risk for persistent trophoblastic disease. The paper details the management and follow-up of this patient.