Esophageal Obturator Airway Esophageal Gastric Tube Airway Eoaegta

The EOA, a 34-cm tube (Fig 14-5^), is placed by flexing the neck and blindly inserting the device into the esophagus. The closed-tube distal cuff is inflated and the more proximal holes allow pressurized air to enter the hypopharyngeal area for ventilation. The EOA has a proximal face mask that requires a good seal to ensure adequate ventilation. The primary benefit is placement without direct laryngeal visualization. The secondary benefits are prevention of gastric distention, regurgitation, and aspiration. The esophageal gastric tube airway (EGTA) ( Fig, 1.4-5B), a modification of the EOA, has an open distal tube containing a valve that allows passage of a nasogastric tube.

Once placed, the EOA is left alone until definitive oral endotracheal intubation is performed, at which point the EOA tube is pulled. EOAs have been shown to be more effective in oxygenation than mask ventilation, but the potential complications are the main reason this tool is used only when endotracheal intubation is not an option. Inadvertent tracheal intubation occurs in approximately 4 to 10 percent of cases. Esophageal injury, including laceration, occurs in up to 10 percent and perforation in approximately 2 percent. Related mortality is 10 to 15 percent. Other considerations include the possibility of vomitus with aspiration and difficulty in maintaining a good seal with the face mask.

Since airway management in the prehospital setting is now more sophisticated in most jurisdictions than it was in the past, the use of EOAs has become quite uncommon. One study showed that some physicians had never seen an EOA, and unfamiliarity is reason enough to avoid using this tool.

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