Unrecognized esophageal intubation with both esophageal obturator airway and endotracheal tube

Two trauma patients with fatal injuries had unrecognized esophageal insertion of an endotracheal (ET) tube despite the presence of an esophageal obturator airway (EOA). Prehospital training must emphasize clinical verification of correct airway placement. If adequate ventilation is obtained with an EOA, endotracheal intubation should not be performed in the field. The EOA does not necessarily guide the ET tube into the trachea. Difficulty removing an EOA after insertion of an ET tube may indicate that both are in the esophagus.