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Correspondence  |   June 2007
Prediction of a Low Success Rate of Astronauts in Space in Performing Endotracheal Intubation
Author Affiliations & Notes
  • Michael Frass, M.D.
    *
  • *Medical University, Vienna, Austria.
Article Information
Correspondence
Correspondence   |   June 2007
Prediction of a Low Success Rate of Astronauts in Space in Performing Endotracheal Intubation
Anesthesiology 6 2007, Vol.106, 1248. doi:10.1097/01.anes.0000265463.99592.91
Anesthesiology 6 2007, Vol.106, 1248. doi:10.1097/01.anes.0000265463.99592.91
In Reply:—
We appreciate the letter by Roan and Boyd regarding our article.1 Their footnotes are presentations at specialty meetings and no data are available for review; therefore, these footnotes cannot be regarded as legitimately indicating that the Fastrach Laryngeal Mask Airway  ™ (LMA  ™; LMA North America, Inc., San Diego, CA) has already been used on the space shuttle. We agree that the learning curve should require little experience to master and maintain proficiency. In this letter, we want to explain why we believe that the Combitube® (Tyco Healthcare, Nellcor Mallinckrodt, Pleasanton, CA) is superior to the LMA  ™.
First, it provides an almost perfect seal against aspiration especially in vomiting and bleeding patients.2–4 Second, it allows application of high ventilatory pressures.3 Third, the diameter of the Combitube® is very small and therefore allows insertion even in patients with a small interincisor distance and/or trismus. Fourth, training time is short.5 Fifth, studies with the Combitube® show that skills are not only easily acquired but also easily maintained even in small emergency medical systems when the device is used only once in a period of 18 months.2–4 Sixth, all studies directly comparing the LMA  ™ and the Combitube® are in favor of the Combitube®: Emergency medical technicians rate the Combitube® best with regard to overall performance and adequacy of airway patency and ventilation; success rates of insertion and ventilation are highest with the Combitube®.3 Seventh, significantly more emergency care physicians prefer the Combitube® as a nonsurgical alternative for coniotomy as compared with the LMA  ™.5 Physicians rate the Combitube® best with regard to effectiveness and easiness to learn.5 Eighth, the Combitube® has proven to be a salvage airway when conventional rapid sequence tracheal intubation fails with no reported complications.6 Ninth, the Combitube® is used as a salvage airway by anesthesiologists when tracheal intubation or LMA  ™ fail in out-of-operating-room resuscitation.7 
We strongly emphasize training of whatever device is being used. Although the LMA  ™ provides a fascinating outstanding concept for in-hospital routine use, the obstacles of inadequate prevention of aspiration and inability to apply high ventilatory pressures limit its value in emergencies.
*Medical University, Vienna, Austria.
References
Rabitsch W, Moser D, Inzunza MR, Niedermayr M, Kostler WJ, Staudinger T, Locker G, Schellongowski P, Wulkersdorfer B, Rich JM, Meyer B, Benumof JL, Frass M: Airway management with endotracheal tube versus  Combitube® during parabolic flights. Anesthesiology 2006; 105:696–702Rabitsch, W Moser, D Inzunza, MR Niedermayr, M Kostler, WJ Staudinger, T Locker, G Schellongowski, P Wulkersdorfer, B Rich, JM Meyer, B Benumof, JL Frass, M
Lefrancois DP, Dufour DG: Use of the esophageal tracheal Combitube by basic emergency medical technicians. Resuscitation 2002; 52:77–83Lefrancois, DP Dufour, DG
Rumball CJ, MacDonald D: The PTL, Combitube, laryngeal mask, and oral airway: A randomized prehospital comparative study of ventilatory device effectiveness and cost-effectiveness in 470 cases of cardiorespiratory arrest. Prehosp Emerg Care 1997; 1:1–10Rumball, CJ MacDonald, D
Tanigawa K, Shigematsu A: Choice of airway devices for 12,020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998; 2:96–100Tanigawa, K Shigematsu, A
Winterhalter M, Brummerloh C, Luttje K, Panning B, Hecker H, Adams HA: Emergency intubation with Magill tube, laryngeal mask and esophageal tracheal Combitube in a training-course for emergency care physicians [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther 2002; 37:532–6Winterhalter, M Brummerloh, C Luttje, K Panning, B Hecker, H Adams, HA
Davis DP, Valentine C, Ochs M, Vilke GM, Hoyt DB: The Combitube as a salvage airway device for paramedic rapid sequence intubation. Ann Emerg Med 2003; 42:697–704Davis, DP Valentine, C Ochs, M Vilke, GM Hoyt, DB
Mort TC: Laryngeal mask airway and bougie intubation failures: The Combitube as a secondary rescue device for in-hospital emergency airway management. Anesth Analg 2006; 103:1264–6Mort, TC