Retrograde Intubation

Abstract

Airway management in the emergency department is a critical skill that must be mastered by emergency physicians. When rapid-sequence induction with oral-tracheal intubation performed by way of direct laryngoscopy is difficult or impossible due to a variety of circumstances, an alternative method or device must be used for a rescue airway. Retrograde intubation requires little equipment and has few contraindications. This technique is easy to learn and has a high level of skill retention. Familiarity with this technique is a valuable addition to the airway-management armamentarium of emergency physicians caring for ill or injured patients. Variations of the technique have been described, and their use depends on the individual circumstances.

Retrograde intubation in a patient with neglected cervical spine injury for sacral advancement flap

“…4 Although there are some known complications 5 like airway trauma, bleeding from nose/cricothyrotomy site, subcutaneous emphysema, infections and even variable success rates among practitioners 6 ; we did not encounter any problem. Recent advances of retrograde intubation and the combined use with fiber optic bronchoscope 7 , or ultrasound guidance 8 have renewed interest in this old technique.…”

Does the Site of Anterior Tracheal Puncture Affect the Success Rate of Retrograde Intubation? A Prospective, Manikin-Based Study

“…We therefore chose to use manikins that were specifically designed for percutaneous cricothyrotomy and RI. Other authors have also reported the successful use of manikins to simulate RI in humans [9, 35]. The manikin was designed for identification of the cricothyroid space; the cricotracheal area, however, was not easily palpable.…”

“…RI has been documented in pediatric patients as young as 5 months old [3]. The elective use of RI has been well documented in patients with angioedema [4], deep neck infections [5], burns [6], trismus [7], musculoskeletal disorders [8], and patients in the prehospital or emergency room [9] and trauma [10, 11] settings. Contraindications to the procedure include coagulation abnormalities, infection at the intended site of the puncture, pretracheal mass, and poorly palpable landmarks in the neck [12].…”

A reply

“…In many parts of the world the new technology, or the expertise to use it, is not available. The retrograde technique, for good reasons, is still being recommended in the developed world, even in non‐anaesthetic environments [6].…”