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Case

Esophageal

Obturator M. JOYCE

Reports

Airway: PAlS’

AND

Radiographic HOWARD

The esophageal obturator airway, developed by Don Michael et al. [1], is a simple tool to improve ventilation du ring cardiopulmonary resuscitation (CPR) Paramedic and other CPR support personnel can be easily trained to effectively use the esophageal obturator airway to

usually room.

maintain

breathing

and

circulation

until

the

patient

possible

tion

in

at the

National

in emergency the

Conference

cardiac

management

of

care cardiac

as

A 58-year-old

on Standards ‘

‘a recent

arrest

recognition

by the

radiologist

will

avoid

confusion.

American

Indian

Report woman

had many past medical

problems, including diabetes and a cerebro vascular accident sustained 1 year before admission that left her with a spastic left hemiparesis and expressive aphasia. About 1 week before admission, she was seen as an outpatient for a left lower lobe pneumonia. Later, she developed respiratory arrest, and a paramedic introduced an esophageal obturator airway while she was still at home. in the emergency room, an endotracheal tube was inserted and radiography demonstrated both the

device, designed by Gordon in 1970 (cited in [2]), has been used by the Los Angeles Fire Departmont paramedic and other CPR teams [2-5]. In May 1973 accepted

on initial radiography in the emergency if it has not been removed before initial

Case

is reduced. A modified

it was

not seen However,

can

be transported to a hospital for other life support systems, such as endotracheal intubation. A laryngoscope is not needed for insertion and the danger of aspiration

for CPR

B. SEGAL’

radiography,

.

Appearance

innova-

patient”

[6],

and it has been designated one of the basic life support systems by the American Heart Association [6]. A face mask is attached to a cuffed tube that is passed blindly into the esophagus. A soft plastic obturator blocking the distal end of the tube is inflated once the cuff is passed. At the upper end of the tube (near the hypophanynx) are 3 mm holes (fig. 1). The face mask is placed tightly over the mouth and nose and ventilation using

air

(mouth-mouth)

or

oxygen

(which

prevents

air

leakage through the nose or mouth) is begun. Sealing the distal end precludes air from entering the stomach, as well as vomiting and aspiration. If the facilities and personnel are available, endotracheal intubation is instituted. Since vomiting often accompanies tube removal, it is not removed until after the endotracheai tube has been

inserted.

Contraindications airway

are

for

a conscious

using patient,

the esophageal any

patient

obturator under

age

15,

and those with known esophageal cancer or other esophageal lesions. Complications include unrecognized endotracheal intubation; in the conscious patient, vomiting against the inflated balloon that results in esophageal injury; traumatic laceration of the airway including the hypopharynx; vomiting after removal; and inflation of the stomach if the balloon is not adequately inflated [7].

Since the esophageal immediately after insertion

obturator airway of the endotracheal

Fig. 1 -Esophageal obturator airway. Air or oxygen enters proximal end through small holes and is forced into trachea. Balloon at distal end (arrow) occludes esophagus to prevent vomiting.

is removed tube, it is

Received September 1 , 1978; accepted after revision October 17, 1978. I Department of Diagnostic Radiology, Yale University School of Medicine, requests to M. J. Pais. AJR 132:267-268, © 1979 American

February

1979

Roentgen

Ray Society

267

333 Cedar Street,

New Haven,

Connecticut

06510.

Address

0361-803X/79/1322-0267

reprint

$0.00

268

CASE

REPORTS

AJR:132,

February

1979

airway in the right main stem bronchus and the esophobturator airway (fig. 2). The tracheal tube was relocated and the esophageal obturator airway removed. Blood gases were satisfactory. However, because of her numerous systemic problems, the patient died 3 days later.

tracheal

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ageal

Discussion Since

esophageal

obturator

widely throughout the interpreting radiographs appearance should

of a ballooned also

ognized the

be aware

endotracheal

airway

with

tinum,

vomiting

monia,

though

airways

country should

that

tube

after rare,

without

used those the

in the

esophagus. such

traumatic

associated

withdrawal, may

are

complications,

intubation, or

being

by paramedics, be able to recognize

They as unrec-

laceration

of

pneumomedias-

and

aspiration

pneu-

occur.

REFERENCES 1.

Don Michael TA, airway for cardiac

2. Farley 95,

Lambert EH, Mehran A: Mouth-to-lung resuscitation. Lancet 2 : 1329, 1968 M: The esophageal obturator airway. Respir Ther

3:

1973

3. Greenbaum DM, Poggi J, Grace WJ: Esophageal obstruction during oxygen administration: a new method for use in resuscitation . Chest 65 : 188-1 91 , 1974 4. Smock SN: Esophageal obturator airway: preferred CPA technique.JACEP 4:232-233, 1975 5. Schofferman J, Oill P, Lewis AJ: The esophageal obturator airway-a clinical evaluation. Chest 69:67-71, 1976 6. Standards for cardiopulmonary resuscitation (CPA) and emergency cardiac care (ECC). JAMA [Suppl] 227:833-868, Fig.

2.-Esophageal (arrowheads).

esophagus chus (arrow).

obturator

Endotracheal

airway

with

inflated

balloon

in

tube is in right main stem bron-

1974

7. Johnson KR, Genovesi MG, Lassar rator airway; use and complications.

KH: Esophageal JACEP 5:36-39,

obtu1976