Retrograde intubation using a guidewire was first described in 1960. The technique involves puncturing the trachea (usually at the cricothyroid membrane) with a large bore needle (e.g. 16 gauge), passing a guidewire into the trachea, and then threading the guidewire cephalad. Once visualized in the oropharynx, an endotracheal (ET) tube can then be threaded over the guidewire and passed through the airway. This technique can be especially helpful in challenging obstructed or “dirty” airways with poor visualization of the vocal cords. A review article by Dhara is a great, comprehensive overview of the procedure (1). Several case reports and studies also suggest that this may be a procedure that should be considered by emergency physicians, rather than performing a cricothyrotomy, in the “cannot intubate, cannot ventilate” situation.

Kathryn McGregor, MD; Taylor Wahrenbrock, MD; Eric Leser, MD