The Esophageal-Tracheal Combitube (ETC) is a doublelumen airway device that is used to secure ventilation through blind placement into the oropharyngeal cavity. This is a supraglottic airway that is most commonly inserted into the esophagus, but can also be blindly inserted into the trachea, though this is uncommon and usually occurs inadvertently (Fig. 25-1). Careful auscultation will allow the operator to determine whether the ETC is in the esophagus or the trachea. Tracheal insertion allows the operator to use the Combitube as a standard endotracheal tube. The ETC has two inflatable cuffs to seal the airway and allow ventilation. The proximal cuff (oropharyngeal cuff) is larger in volume and can be inflated with up to 100 cc of air, depending on the size of the Combitube. The distal cuff is smaller and is inflated in either the esophagus or the trachea with 10 to 15 cc of air, depending on the size and position of the device. The double-lumen design allows for ventilation while passing an orogastric tube through the smaller lumen to decompress the stomach. The longer of the two lumens, or the blue lumen, has side ports for ventilation within the pharynx and ends blindly. The ETC comes in a standard size (42 French) and a smaller size (37 French) for smaller individuals.

The ETC has been used successfully as an airway for several years by trained and untrained operators for both routine and emergent airway management. It has been used for prehospital management,¹ for routine airway management for operative procedures, and during cardiopulmonary resuscitation.² A comparison of the ETC with the laryngeal mask airway (LMA) when used by staff not previously trained in airway management after induction of anesthesia showed that the ETC can be used successfully by untrained personnel.³ The LMA may be a more practical device for untrained personnel when considering the extra maneuvers for placement of the ETC and its higher cost. The advantage of the ETC in the emergent setting is that it provides better protection from aspiration with its double-lumen design. There have been reports of successful use of the ETC in the intensive care setting,⁴ but case reports of tongue engorgement have suggested that longterm use may increase the risk of airway complications.⁵ Ischemia-reperfusion injury or compression of the glossal blood vessels were suggested as possible causes of this complication. Pressures that are up to three times higher than the mucosal perfusion pressure have been measured in properly inflated pharyngeal cuffs.⁶

Force upon insertion of the ETC should be avoided, as it may cause esophageal rupture,⁷ subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum.⁸