Literature Review: Securing the ET Tube

Owen R, Castle N, Hann H, et al. Extubation force: A comparison of adhesive tape, non-adhesive tape and a commercial endotracheal tube holder. Resuscitation 80(11): 1,296-1,300, Nov. 2009.

Abstract

This study compares adhesive tape, non-adhesive tape and a commercial endotracheal tube holder in terms of the force required to extubate endotracheal tubes from a cadaver.

Methods--A newly deceased, unembalmed cadaver was orotracheally intubated. Senior paramedic students secured the endotracheal tube using adhesive tape applied using the Lillehei method, non-adhesive tape and the Thomas Tube Holder in a random order. The time taken to secure the endotracheal tube and the force required to remove the distal tip of the endotracheal tube from the glottis were recorded.

Results--Use of adhesive tape using the Lillehei method resulted in greatest resistance to tube dislodgement, although it took significantly longer to apply than the other two methods.

Conclusion--Although the Lillehei method provided the greatest resistance to tube dislodgement, it may not be ideal for the prehospital or emergency department context. The Thomas Tube Holder was quick and effective and may provide a good compromise in these environments, although once time is no longer important, clinicians may elect to revert to the Lillehei method, which provides greater security.

Comment

After an endotracheal tube is inserted and its position confirmed, it is critically important that it remain in place. This is particularly concerning in the prehospital setting because: 1) it is often difficult to detect when an ETT has been later dislodged, and 2) after cervical immobilization and once en route, replacement of a dislodged ETT can be much more difficult, if not impossible. Previous studies have looked at methods to properly secure an ETT, and most have come to the same conclusion: that a commercial device, though more expensive than tape, is quick, easy and highly effective. As an example, Dr. Jestin Carlson (Ann Emerg Med 50:686) reported that the Thomas Tube Holder was better than adhesive tape and three other commercial devices. The authors here also found the Thomas was the best device when considering both speed of use and security. To help avoid complications of ETT dislodgement, EMS systems should evaluate methods of securing ETTs and consider standardizing on one simple and effective device.

Angelo Salvucci, Jr., MD, FACEP, is an emergency physician and medical director for the Santa Barbara County and Ventura County (CA) EMS agencies.