II. Indications
- Difficult Endotracheal Intubation despite ability to oxygenate and ventilate a patient in need of Advanced Airway
- Procedure allows for continued ventilation and oxygenation during procedure
III. Preparation
- Retrograde Intubation kits (e.g. Cook) are available
- Central Line kit may be used instead
- Airway exchange catheter kit may also be used
- Introducer needle (that allows passage of the seldinger wire)
- Syringe
- Seldinger Guidewire
- Stiffer guidewires are preferred (e.g. 145 cm angiowire) if available
- Hemostat
IV. Technique
- Continue Bag Valve Mask until Endotracheal Tube insertion
- Perform Needle Cricothyrotomy
- Insert introducer needle through skin and angled toward the oropharynx
- Pass introducer needle through skin and cricothyroid membrane and into trachea
- Aspirate while inserting needle until aspirating air easily
- Insert Seldinger guidewire
- Thread the wire up until it is visualized in the oropharynx
- Apply hemostat to the end of the guidewire at the neck insertion site (prevents migration)
- Allow for slack at the guidewire insertion to allow for greater depth of ET Tube insertion before guidewire removal
- Insert Endotracheal Tube
- Thread the guidewire through the murphy eye hole at the end of the Endotracheal Tube
- Pass the Endotracheal Tube over the guidewire until it has passed through the Vocal Cords
- Remove the guidewire
- Pass the Endotracheal Tube further to its full insertion point and inflate balloon
- Confirm Endotracheal Tube placement
- End tidal CO2
- Chest and Abdomen auscultation
- Chest XRay
V. References
- Braude and Weingart (2024) Retrograde Intubation, EM:Rap 24(1)
- Guest and Catalano (2023) Retrograde Intubation, EM:Rap 23(11)