[A modified technique of retrograde intubation using gastric tube--a manikin study].

BACKGROUND

Airway management is a critical skill that must be mastered by all emergency physicians. Retrograde intubation was first described in 1960, and since then it has been used as an alternative method when the classical approach to establish an artificial airway fails. Although it may be difficult due to anatomical and/or technical reasons, it requires limited equipment, is easy to learn, and has few contraindications

METHODS

The author presents their own modification of the standard technique of retrograde intubation, using a gastric tube as a guide. After puncture of the cricothyroid membrane and passage of a guide wire (epidural catheter), a gastric tube is passed over the guide wire in a retrograde direction, through the previously dilated cricothyroid membrane, instead of via mouth. An endotracheal tube is then advanced over the gastric tube and inserted into the trachea.

RESULTS

The method was tested and compared with a standard one on a manikin model by 38 anaesthesiologists and anaesthesia residents. The success rate was 96% for the modified method, and 65% for the standard method.

CONCLUSION

The retrograde passage of a guide catheter (e.g., gastric tube) through the cricothyroid membrane may be more effective than the routine method, when it is introduced though the mouth.