Retrograde Intubation vs. Crichotyrotomy

qanik1 · Oct 8, 2005

I think some good points have been made in several previous post. I would like to add my experience with both. Having been a paramedic for 19 years and a nurse for 16 the last 12 as a flight nurse I have had to perform only 4 crichs- thankfully. 3 were helmetless motorcyle drivers that ended up with severe mandible trauma and the 4th was a burn that was 35 minutes old upon our arrival. At my program we don't perform needle crichs as early on in the program they had no success as blood and vomit ended up occluding the catheters so we go straight to surgical crichs placing 6.0 shileys. All went well- in fact they left one of them in for three days before going to a trach. I have tried the retrograde only once. I was unable to get the wire out the mouth. I should say again it was a trauma with teeth and vomit and everything else in his stomach pouring out everywhere. I aborted the procedure and performed a crich. I should say that I am in my last year of CRNA school and have noticed a tremendous difference in the thought process of the two fields. I have been fortunate to have had some wonderful CRNA' s and Docs teaching me. I have been taught so many tricks and back up tools and plans with regard to meds and equipment. The one thing I can't get over is the ego of some of the docs at certain facilities with regard to failed or difficult airways. I just can't believe the number of failed attempts at laryngoscopy that just go on and on and on. No bother trying to ventilate with a mask-Then another doc will try and try. Then the fiber optic is pulled out and useless because they have trashed the airway. Then they are screaming for ENT- all the while with the ASA difficult airway chart staring at them on the wall. As I sit in the corner as I am "only a student" I can't help but think why don't they bag the patient and move on to a back up plan.

Respectfully,

Qanik

mwbeah · Oct 8, 2005

MWBEAH you were lucky you got the J-wire (central line wire) to the oropharynx...

I can't disagree with that, had to try something. I did reverse the J wire though and it passed pretty easily and actually was able to have it exit the right nare (we needed a nasal intubation).

Mike

tridil2000, MSN, RN · Oct 8, 2005

What is the benefit of retrograde intubation as an emergency airway versus crichothyotomy? I was reading an article on retrograde intubation the other day and I've never seen one performed in our ER, but I have seen a crich or two. I was just wondering if there is a benefit of one or the other. It seems to me that retrograde intubation also involves cutting the crichothyroid membrane, although i guess a needle insertion to pass a guidewire is less invasive than placing the airway there. Is that it?
Just curious.
bryan

fyi, nice website to view!

http://www.biodigital.org/voz2/open.htm

zrmorgan · Oct 15, 2005

to the soldier with the Iraq experience- thanks for the case example, and thanks for going to Iraq for us.

to anyone who has ever attempted a retrograde-

have you ever had a problem passing the guidewire (eg edema/ obstruction cephalad to the wire insertion point? It seems to me there would be a lot of anxiety looking for a small wire to arise from a possibly distorted naso/oropharnyx. And although a wire may thread through an airway, would an ett several times its diameter thread back down?

just curious...it seems to me a retrograde might be attempted with adequate preparation and time for oxygenation. I wonder about its value as an emergency technique in patients with little reserve.

mwbeah · Oct 15, 2005

to the soldier with the Iraq experience- thanks for the case example, and thanks for going to Iraq for us.
to anyone who has ever attempted a retrograde-
have you ever had a problem passing the guidewire (eg edema/ obstruction cephalad to the wire insertion point? It seems to me there would be a lot of anxiety looking for a small wire to arise from a possibly distorted naso/oropharnyx. And although a wire may thread through an airway, would an ett several times its diameter thread back down?
just curious...it seems to me a retrograde might be attempted with adequate preparation and time for oxygenation. I wonder about its value as an emergency technique in patients with little reserve.

Thanks for the support,

The good thing is that if the wire is of sufficient length, you will be able to try a few sizes if need be.

Take Care,

Mike

Mike the Hunter RN · Jan 23, 2006

Please excuse my computer/internet stupidity as this is the first time I've tried to enter a "chat room". I got here because I did a yahoo search for jet insuflation. My ED's jet insuflation device has disappeared (imagine that, something disappearing from an Ed) and the hospital's respiratory dept. has not been any help in locating another. Can someone please look at your device and get me a brand name? If I get that, I should be able to find a vendor.

Dr.sasidhar · May 6, 2010

the most important indication of retrograde intubation is in patients where mouth opening is not adequate to perform anterograde intubation...........retrograde intubation is not usually used as emergency procedure....for emergencies cricothyrotomy is more suitabe....