Retrograde intubation

[EMS_Cadet]

I just recently heard of an EMS service utilizing retrograde intubation. Is this common? Is this usually something that is medical command or protocol?

[AZCEP]

If you have to ask your medical control if you can perform a procedure to secure an airway, there might be bigger problems than how you go about doing it. Here it is a protocol item. Our medical control would prefer them to the surgical cricothyrotomy, but it does take a bit longer to perform.

Retrograde intubation is not all that difficult to perform, but you don't need it very often. Most providers are capable of securing a surgical airway if needed. If they can't, then the retrograde option is a pretty good one.

[Ridryder 911]

I have done about 8 or 9 retrogrades... personally, it could be used as a option, but; I feel it is a waste of time. Why not crich them and be done with it ?... It takes longer, and usually ask yourself afterwards, why didn't I just crich them ? ...

The kits are expensive as well. I suggest placing the money and time in other airway devices and airway education.

Good luck,

R/r 911

[flight-lp]

there seemed to be a big "retrograde" kick last year, but it seems to have fizzled out. Retro is an option, but one that a Paramedic who doesn't know what he's doin' can easily f#$% up. If you can't see the cords, try a bougie, reposition (if feasible), and try again. If after 3 attempts you can't get it, drop a failed airway adjunct. If ventilating becomes an issue, then cric 'em. Considering the recent debate on medics not being able to secure an airway worth a sh*^, I would probably avoid potentially lacerating someones tracheal arteries with a wire.................

[ERDoc]

Does anyone carry a Bullard scope on their ambulance? It's expensive, but it works great. I've used it on a few difficult airways and on a few that I thought were going to be difficult.

[Spock]

I thought the retrograde intubation concept had disappeared. Rid-what kind of patients were retrograde intubations necessary? With 8-9 you are the expert here.

Live long and prosper.

Spock

[ffpm41]

I've seen retrograde used several times, including in the ED with more failures than success. I also just attended the The Difficult Airway Course: EMS and it was great. They asked the 50+ medics, RN's, and MD's in the room who still uses Retro and no one raised their hands. Check out the link for more information including video's on airway management. The book is also a great tool.

The Airway Site

With the advent of fiber optic blades, the Trachlight, Intubating LMA's, bougies, etc, I think retrograde has outlived it's usefullness.