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Wed Jul 16 09:38:08 BST 2003

Here in Quebec, the Combitube is the only tube used to secure the airway
in the prehospital arena.

We have seen many (too many!!) oesophageal perforations when we began
using the Combitube.  Inadequate technique and using the tube when
contra-indicated (as in this case, "combative" patient) was the main
reason.  The tube has been used now for a few years and I haven't seen
an oesophageal perforation for years.  Unfortunately I don't have the
numbers.

Regards,

Jean Levasseur MD
CHRDL, Joliette, Quebec
Chief of the intensive care unit

-----Message d'origine-----
De : trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] De la part de Sherry, Scott :LPH
Trauma
Envoyé : 15 juillet, 2003 20:20
À : 'Trauma & Critical Care mailing list'
Objet : RE: Esophageal perforation from a combi-tube. - More info

Assaulted GCS of 3 on scene as reported by medic (paper) report.. came
up to
about a 5 and was combative. they attempted multiple ETT placement and
then
inserted combitube (so was the combitube directly to blame?? hmmmm). The
dx
was picked up a couple of days later. 

lit is scant on this. there are a couple of articles on this. the only
prehospital comment was an article from Japan and they stated out of
1600
combitube placements there were around 9 perfs. seems high to me though.
This was accessed via pub med --- "esophageal perforation and combitube"

The one case report I found was from the UK 1998 in aneth analg by Klein
et
al and that is in reference to an in hospital elective placement of a
combitube.  no other case reports on prehospital perfs. 

I am continuing to dig into the mystery. The patient is supposed to be
presented this week for morning conference. Should be interesting. 

Scott...

-----Original Message-----
From: Andrew J Bowman [mailto:sumieb at compuserve.com]
Sent: Tuesday, July 15, 2003 4:02 PM
To: Trauma & Critical Care mailing list
Subject: Re: Esophageal perforation from a combi-tube. 

Had  a patient last year, had received treatment for lung cancer in past
(radiation to chest).  Experienced cardiac arrest and EMT's placed a
combitube.  Upon arrival at first ER it was opted to leave in place and
was
then transferred to my ER.  On arrival had SQ air.  Further workup
showed a
perfed esophagus, thought likely to esophageal tissue friability from
prior
radiation.

Developed mediastinitis and died.

Andrew Bowman
----- Original Message -----
From: "Sherry, Scott :LPH Trauma" <SSherry at LHS.ORG>
To: "Trauma-List (E-mail)" <trauma-list at trauma.org>
Sent: Tuesday, July 15, 2003 4:26 PM
Subject: Esophageal perforation from a combi-tube.

>
> Interesting case. We have a 22 yo male s/p assault, head bleed, and an
> esophageal perforation as a result of a combitube attempt. I will have
to
> dig a little more into this but was wondering if there was much info
and
> experience on this (i.e. combitube perforation) out there on this
list.
The
> OMFS team doesn't feel surgery is warranted at this point. They
commented
on
> this being quite rare.
>
> Feedback welcome. I am going to review the lit on this one.
>
> Scott...
>
>
>
>
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Esophageal perforation from a combi-tube. - More info