Study objective: To evaluate the ability of paramedics in a nonurban emergency medical services system to use the Combitube, a combined endotracheal and esophageal obturator airway adjunct, in prehospital cardiac arrest patients.
Design: A prospective, controlled study to evaluate the difficulty and complications of insertion, recognition of esophageal versus tracheal placement, skill proficiency, and retention. The ability to use the device in cases of failed endotracheal intubation also was scrutinized.
Setting: Evaluation of the paramedic's ability to use the Combitube was performed in a prehospital environment. A follow-up study to determine retention of insertion skill was conducted in a controlled laboratory setting.
Interventions: Fifty-two cases of paramedic prehospital Combitube insertion were examined, and 11 paramedics were evaluated for skill retention.
Measurements and main results: Combitube insertion was attempted on 52 prehospital patients in cardiac arrest, and 69% were intubated successfully. Paramedics recognized esophageal versus tracheal placement in 100% of the cases. The Combitube was inserted successfully into 64% of the patients who could not be endotracheally intubated by the conventional visualized method. The Combitube was inserted successfully 71% of the time when used as a first-line airway adjunct. A follow-up study on 11 randomly selected paramedics involved in the field study was conducted 15 months later. Nine of 11 paramedics demonstrated inadequate skill retention in the follow-up study.
Conclusion: Although visualized endotracheal intubation remains the preferred method of airway control, the Combitube may be an effective prehospital airway device as both a backup to the endotracheal tube and a primary airway. Although the Combitube does not require visualization with a laryngoscope, comprehensive training and continuing education are key factors affecting skill retention.