[Retrograde intubation in an emergency situation - indication, technical performance, risks and pitfalls]

Retrograde intubation is an alternative technique to endotracheal intubation. It is used for the management of expected or unexpected difficult intubation. The indication for use of this technique is, above all, a situation in which a flexible bronchoscope, a video laryngoscope or other alternative devices are not available or, respectively, when their use is - or appears to be - not possible due to bleeding and secretions or other particular anatomic pathological conditions. Although the necessary equipment for a retrograde intubation is frequently available, the technique is rarely used, especially in the German-speaking regions.The present article describes the technical steps of retrograde intubation and discusses its possible risks and pitfalls. Furthermore, modifications that facilitate the technical procedure are presented. This contribution is intended to promote the acceptance and use of this less invasive technique in order to avoid possible injury to the patient due to hypoxia, trauma of the airways, and surgical emergency procedures or tracheotomies during the management of difficult airway conditions.