Retrograde Endotracheal Intubation: an Investigation of Indications, Complications, and Patient Outcomes

The objective of this study was to review indications for retrograde endotracheal intubation (REI) and to examine outcomes and complications associated with this technique. We reviewed all intubations of adult emergency department patients over an 8-year period. A total of 1681 charts were reviewed with 313 excluded because of inadequate documentation of intubation. Of the 1368 remaining charts, we found that REI was attempted in 8 cases. Indications for REI included trauma (n=4) and non-trauma-related respiratory distress (n=4). Complications included inability to locate the cricothyroid membrane (n=2), inability to pass the endotracheal tube through the vocal cords (n=1), and procedure time of more than 3 minutes (n=4). Retrograde endotracheal intubation was successful in securing the airway in 4 cases and unsuccessful in 4 cases. We found that although REI was attempted for trauma and non-trauma-related respiratory compromise, it was associated with multiple complications, and successful in only 4 of 8 cases.