Rich James M, Mason Andrew M, Bey Tareg A, Krafft Peter, Frass Michael
Department of Nurse Anesthesia, Baylor University Medical Center, Dallas, Tex., USA.
AANA J. 2004 Apr;72(2):115-24.
Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event (e.g., inadequate mask ventilation, failed tracheal intubation, or cannot ventilate-cannot intubate). Recommended options to resolve a critical airway event include the laryngeal mask airway, the esophageal tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway to avoid potential neurological disability or death. Part 1, which was published in the February 2004 AANA Journal, reviewed use of the ETC in combination with the self-inflating bulb and/or portable carbon dioxide detector as an effective rescue airway system. Important aspects of rescue ventilation, ETC training methods, how to use the ETC, and determining ETC location also were reviewed. Part 2 reviews ETC advantages, contraindications, and reported complications in prehospital, emergency medicine, and anesthesia settings. Safe methods to exchange the ETC for a definitive airway also are described. Major ETC advantages include the following: (1) easy to learn, (2) can be inserted rapidly, (3) effectively secures the airway, (4) provides adequate lung ventilation, (5) minimizes aspiration risks, (6) facilitates application of high ventilatory pressures, and (7) can be exchanged safely for a definitive airway without compromising airway control or protection.
紧急和意外的困难气道管理可能会迅速恶化为危急气道事件（例如，面罩通气不足、气管插管失败或无法通气-无法插管）。解决危急气道事件的推荐方法包括喉罩气道、食管气管联合导管（ETC；泰科医疗-内尔科尔公司，加利福尼亚州普莱森顿）、经气管喷射通气或建立外科气道，以避免潜在的神经功能障碍或死亡。发表于2004年2月《美国麻醉护士协会杂志》的第1部分回顾了ETC与自动充气球囊和/或便携式二氧化碳检测仪联合使用作为一种有效的急救气道系统的情况。还回顾了急救通气的重要方面、ETC培训方法、ETC的使用方法以及确定ETC位置的方法。第2部分回顾了ETC在院前、急诊医学和麻醉环境中的优势、禁忌症及报告的并发症。还描述了将ETC安全更换为确定性气道的方法。ETC的主要优势包括：（1）易于学习；（2）可快速插入；（3）有效确保气道安全；（4）提供足够的肺通气；（5）将误吸风险降至最低；（6）便于施加高通气压力；（7）可安全更换为确定性气道，而不影响气道控制或保护。
