Respiratory failure after tracheal extubation in a patient with halo framecervical spine immobilization - rescue therapy using the Combitube airway

A 78-yr-old man, with halo frame cervical spine immobilization, suffered ra pid respiratory deterioration after tracheal extubation in the intensive ca re unit. Control of the airway was difficult as bag-valve-mask ventilation was ineffective, tracheal intubation was known to be difficult from managem ent of a previous episode of respiratory failure on the ward. and laryngeal mask insertion proved impossible. Rescue therapy using a Combitube airway is described and discussed.