Despite the potential utility of the ETC or EzT in the acute setting, several disadvantages must be kept in mind. These include the high cost, bulky packaging, and the fact that the ETC detachable “vomit deflector” can expose providers to gastric contents if improperly managed. It is best not to use the vomit deflector, as it can be associated with aspiration. Several risks are also inherent to the insertion and mechanics of the devices. It should be recognized that the presence of a rigid cervical collar can cause great difficulties in the proper placement of this device.12 The device is most frequently inserted into the esophagus. Therefore, there is a risk of esophageal injury.13 There is no way to suction the trachea with the open distal port in the esophagus. It is important to note that resuscitation drugs that can be routinely given through an endotracheal tube cannot be given through the device positioned with the tip in the esophagus. Drugs will accumulate in the blind end of the tube or the hypopharynx. Significant soft tissue injury can occur due to the tip of the device or if the balloons contain too much air.12,14 If forced, the tip can perforate the esophagus, piriform sinus, or vallecula. The increased cuff pressure of the ETC versus the EzT can result in mucosal injury.15 An overinflated distal balloon located in the esophagus can compress the trachea and cause an airway obstruction.16 Always inflate the balloons with the recommended volume of air and not more. Prolonged use of up to 4 hours can result in the proximal cuff obstructing the lingual veins and resultant tongue engorgement.17 This can result in a difficult intubation when exchanging the device for an endotracheal tube.