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esophageal-tracheal Combitube


The esophageal-tracheal Combitube (ETC) is a double-lumen, double-cuffed tube.

ETC was invented by Prof. Michael Frass (Professor of Medicine, Department of Internal Medicine, Intensive Care Unit, University Hospital of Vienna).

two sizes:


37 F - small adult


41 F - adult



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with the patient’s head in a neutral position,
the lower jaw and tongue are lifted by one hand, the tongue is pressed forwards

during insertion, the tongue should be pressed out of the way with the help of the deeply inserted thumb





the Urtubia maneuver is always useful for blind insertion: the Combitube is held bent between

the balloons for a few seconds to facilitate insertion




the tube is inserted in a curved downward very “flat” movement




ETC can be inserted orally either blindly or with a laryngoscope



5  the tube is inserted until the printed ringmarks lie between the teeth or alveolar ridges


6  first, the oropharyngeal balloon is inflated with 85 ml (Combitube 37 F) or 100 ml (41 F)


7  then, the distal balloon is inflated with 5 to 12 ml (Combitube 37 F); 5 to 15 ml (41 F) 


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8  there is a high probability that the tube will be placed in the esophagus


test ventilation is recommended via the longer blue tube No. 1


air passes through the longer tube, leading to the esophageal lumen, into the pharynx and from there over the epiglottis into the trachea since mouth, nose and esophagus are blocked by the balloons


auscultation of breath sounds in the absence of gastric insufflation confirms adequate ventilation when the Combitube

is in the esophagus




9 when no breath sounds are heard over the lungs in the presence of gastric insufflation, the Combitube has been placed into the trachea


ventilation is changed to the shorter clear tube No. 2, leading to the tracheal lumen


now, air flows directly into the trachea



in a few cases, ventilation does not work via either lumen 

because the Combitube may have been placed too deep

move the Combitube about 3 cm out of the patient’s mouth

and try ventilation again via the esophageal lumen



ETC is contraindicated in:
patients smaller than four feet, Combitube 37 F SA (= small adult) may be used in patients between four and six feet
intact gag reflexes irrespective of their level of consciousness
known esophageal pathology; patients who have ingested caustic substance
obstruction of the upper airways, e.g. foreign bodies, tumors, etc.


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Esophageal-Traqueal Combitube

Michael Frass


Combitube News: emergency medicine


Current Status of the Combitube: A Review of the Literature
Felice Agro, Michael Frass, Jonathan L. Benumof, Peter Krafft


The critical airway, rescue ventilation, and the Combitube: Part 1
James M. Rich, CRNA, Andrew M. Mason, Tareg A. Bey, Peter Krafft, Michael Frass


The critical airway, rescue ventilation, and the Combitube: Part 2
James M. Rich, CRNA, Andrew M. Mason, Tareg A. Bey, Peter Krafft, Michael Frass