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Many EMS services in Wisconsin use a similar dual-lumen airway called the combi-tube which has been around for quite a few years. Apologies in advance if you already know of this. Some services in Wisconsin that are not at the Paramedic level are allowed to be trained to do endotracheal intubations in the field per their medical directors. However, those that are not still need the capability of a more advanced airway than a nasal or oralpharyngeal airway, hence the combi-tube. It is a blind insertion requiring no laryngoscope and is designed to be inserted into the esophagus. Also where the ET intubated patient was most likely supine or possibly in the sitting position (if the individual intubating is experienced) the combi-tube is postion independent due to its blind insertion. If the tube is inserted and gastric sounds are heard upon ventilation using lumen #1 or gastric distension is observed you simply switch to the #2 lumen and try again. Generally this means that rather than going into the esophagus the combtube went into the trachea and can be used as an edotracheal tube including drugs down the tube (if an IV has not been achieved) or a suction catheter down the tube. However, it is a large bulky tube and can and has caused more damage to the patient when being inserted. If the tube is inserted too deeply or not deep enough it will not work. When inserted properly, drugs or suction CANNOT go down the tube because there is no direct path to reach the lungs or trachea. Also if there is massive displacement of the airway for example an unsuccesful attempted suicide by shotgun to the mouth ( i've seen this one) with massive displacement of the maxila and mandible and exposed vocal chords, there is no way in hell you can get that big-ass tube in there to secure that airway. We just used a smaller cuffed ET tube, stuck it in the trachea that we could see, secured it the best we could and loaded him onto the helo. Basically I believe their advertisement is correct in that it is an effective alternative until normal ET intubation can be achieved. It is not a fail-safe airway by any means, just another option at your disposal.
Some sources of info: Mosby's EMT-Intermediate Textbook 1997 edition
Mosby's PHTLS textbook 5th edition 2003
Combi-tube website?
Just for info I am not a paramedic but am trained to do ET intubations per my medical director.
smokfire
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