Esophageal perforation following use of esophageal obturator airway (EOA)

Esophageal perforation following use of the esophageal obturator airway (EOA) has been reported in a small number of patients. However, it has generally been discovered only in the presence of obvious clinical signs in patients otherwise resuscitated from cardiac arrest. Since it may well be overlooked in patients who succumb following the combined insult or primary cardiac arrest and secondary esophageal perforation, the true incidence of this adverse consequence of EOA use is unknown. We present a case of esophageal intubation with the EOA, and review in detail previous reported cases. We further suggest possible mechanisms leading to this catastrophic consequence of intubation with the EOA, and comment on its significance with regard to the controversy over EOA versus endotracheal (ET) tube training for paramedic pre-hospital personnel.