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Fri Sep 1 00:35:51 BST 2006

Further, a quick review of the literature would yield uncommon but very  real 
problems associated with the Combitube, including multiple cases of  
esophageal rupture. I can share multiple anecdotes of the LMA being used  successfully 
as a rescue airway after failed intubation. In the past year at  least two 
adult patient have arrived in our TRU after failed intubation by other  
hospitals and were successfully ventilated and oxygenated without substantial  
aspiration. 

In my own experience, Combitubes are used quite commonly by our ground EMS  
teams, and as a primary airway by some EMT-B and EMT-I level providers, and we  
covert a number of Combitube placements to tracheal tube. Conversion to ETT 
is  much easier with the LMA than with the Combitube. I have had success 
(though the  rate in the literature is low, about 50%) with converting LMA to ETT 
simply by  intubating the trachea with a bougie via the LMA and advancing an ETT 
over the  bougie once the LMA was removed... and what of our children? There 
is no  pediatric version of the Combitube. The LMA has been used world-over as 
a rescue  device for pediatric failed airway, including children with major 
craniofacial  anomalies. 

Mr. MacKinnon, I'm glad to see you can conduct a literature search and  
include only those reviews, that which support your belief. The truth and  reality, 
back down here with the rest of us, about the LMA and it's use as a  rescue 
airway, is that it's NOT nearly as bad of a device as you would paint it,  and 
that the risk of aspiration, is greatly exaggerated by detractors of the  
device such as yourself. 

I'm truly very sorry to inform you, that the LMA has proven it's utility as  
a rescue device in hospitals and in the field the world over. While 
admittably,  the available evidence may be conflicting, we are at the very least assured 
that  aspiration with the LMA is rare, as proven by large trials in important 
and  unbiased efforts by a number of investigators, and there is absolutely 
no  question that it's proven itself. 

My hat is off to Archie Brain. 

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