Abstract
Purpose
To report four cases of subcutaneous emphysema, pneumomediastinum and pneumoperitoneum associated with the use of the Esophageal-Tracheal Combitube® (ETC) during prehospital management of cardiac arrest.
Clinical features
Between September 1994 and April 1996, 1139 patients were resuscitated with the ETC and the semiautomated external defibrillator as part of the CPR protocol for prehospital management of cardiac arrest by basic emergency medical technicians. Eight of these patients presented with subcutaneous emphysema. Four of them, declared dead after arrival in the emergency room (ER), had autopsy studies. In two, autopsy revealed large (6 and 6.5 cm respectively) longitudinal transparietal lacerations of the anterior wall of the oesophagus. Multiple superficial lacerations of the oesophagus were also present in another patient, while no lesion of the airway or the oesophagus was found in the last patient.
Conclusion
These cases suggest that subcutaneous emphysema, pneumomediastinum and pneumoperitoneum might be complications associated with the use of the ETC. At least in two cases, oesophageal laceration appears to be the mechanism by which these complications occurred.
Objectif
Rapporter quatre cas d’emphysème sous-cutané, de pneumothorax et de pneumopéritoine associés à l’usage du Combitube® durant la réanimation pré-hospitalière de l’arrêt cardiaque.
Aspects cliniques
Entre septembre 1994 et avril 1996, 1139 patients ont été réanimés en utilisant le Combitube® et un défibrillateur externe semi-automatique dans le cadre d’un protocole de RCR pour la prise en charge des arrêts cardiaques par des techniciens médicaux d’urgence ayant une formation de base. Huit de ces patients ont présenté de l’emphysème sous-cutané. Quatre d’entre eux, décédés après leur arrivée à la salle d’urgence, eurent des autopsies. Chez deux, l’autopsie a montré d’importantes lacérations longitudinales transpariétales (6 et 6,5 cm respectivement) de la paroi antérieure de l’œsophage. Des lacérations superficielles multiples étaient aussi présentes chez le troisième patient, alors qu’aucune lésion ni des voies aériennes ni de l’œsophage ne fut retrouvée chez le dernier patient.
Conclusion
Ces cas suggèrent une association entre l’emphysème sous-cutané, le pneumo-médiastin et le pneumopéritoine comme complications de l’utilisation du Combitube®. Au moins chez deux patients, des lacérations oesophagiennes semblent être le mécanisme de ces complications.
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References
Frass M. The Combitube: esophageal/tracheal doublelumen airway.In: Benumof JL (Ed.). Airway Management, Principles and Practice, 1st ed. St. Louis: Mosby-Year Book Inc., 1996: 444–54.
American Society of Anesthesiologists Task Force on Management of The Difficult Airway. Practice guidelines for management of the difficult airway. Anesthesiology 1993; 78: 597–602.
Atherton GL, Johnson JC, Ability of paramedics to use the Combitube™ in prehospital cardiac arrest. Ann Emerg Med 1993; 22: 1263–8.
Lefrançois D, Défibrillation préhospitalière dans un système non médicalisé. Isis-Urgence Pratique 1995; 12: 15–21.
Wee MYK, The oesophageal detector device. Assessment of a new method to distinguish oesophageal from tracheal intubation. Anaesthesia 1988; 43: 27–9.
Frass M, Frenzer R, Zdrahal F, Hoflehner G, Porges P, Lackner F, The esophageal tracheal Combitude: preliminary results with a new airway for CPR. Ann Emerg Med 1987; 16: 768–72.
Frass M, Frenzer R, Mayer G, Popovic R, Leithner C, Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit. Arch Emerg Med 1987; 4: 219–25.
Frass M, Frenzer R, Rauscha F, Weber H, Packer R, Leithner C, Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation. Crit Care Med 1986; 15: 609–11.
Frass M, Frenzer R, Rauscha F, Schuster E, Glogar D, Ventilation with the esophageal tracheal combitube in cardiopulmonary resuscitation. Promptness and effectiveness. Chest 1988; 93: 781–4.
Johnson KR Jr, Genovesi MG, Lassar KH, Esophageal obturator airway: use and complications. JACEP 1976; 5: 36–9.
Strate RG, Fischer RP, Midesophageal perforations by esophageal obturator airways. J Trauma 1976; 16: 503–9.
Hoffman JR, Pietrafesa CA, Orban DJ, Esophageal perforation following use of esophageal obturator airway (EOA). Am J Emerg Med 1983; 3: 282–7.
Combitube™ Package Insert. Kendall Sheridan Catheter Corp., Argyle, NY, 1995.
Wafai Y, Salem MR, Baraka A, Joseph NJ, Czinn FA, Paulissian R, Effectiveness of the self-inflating bulb for verification of proper placement of the esophageal tracheal combitube®. Anesth Analg 1995; 80: 122–6.
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Vézina, D., Lessard, M.R., Bussières, J. et al. Complications associated with the use of the Esophageal-Tracheal Combitube. Can J Anaesth 45, 76–80 (1998). https://doi.org/10.1007/BF03011999
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DOI: https://doi.org/10.1007/BF03011999