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May 23, 1977

Accidental Intubation of the Pyriform SinusA Complication of "Roadside" Resuscitation

JAMA. 1977;237(21):2324-2325. doi:10.1001/jama.1977.03270480064025

PERFORATION of the hypopharynx during endotracheal intubation is most likely to occur in emergency settings such as cardiopulmonary resuscitation, but it may also occur in more controlled situations. The injury has been related to the urgency of the intubation and to the inexperience of the person performing the intubation.1

The esophagus is the most commonly reported site of perforation, and barotrauma and abscess formation the most likely complications. While signs of barotrauma become evident soon after perforation, neck abscess does not become apparent for several days or weeks.

Report of a Case  A 58-year-old woman was brought to the emergency room by ambulance with apparent cardiorespiratory arrest. She was well 3 1/2 hours prior to admission. Shortly thereafter, she was found on the floor of a closed garage with a car engine running.Resuscitative measures were instituted by trained emergency medical technician personnel of a city ambulance crew. The