Rapid sequence tandem intubation to navigate a subglottic obstruction

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pulmonology

Background:

• Effective emergency airway management hinges on selecting optimal tools for anticipated challenges.
• Video laryngoscopy and flexible endoscopy are standard techniques for managing difficult airways.

Observation:

• A 53-year-old female presented with mixed respiratory failure due to an obstructing lung mass.
• Imaging revealed a tortuous subglottic obstruction, rendering non-invasive support insufficient.

Findings:

• Neither video laryngoscopy nor flexible endoscopy alone was deemed adequate for intubation.
• A novel tandem intubation strategy, sequentially employing both methods, was successfully implemented.

Implications:

• This case highlights the utility of tandem intubation in managing complex airway obstructions.
• The described technique offers a viable approach for challenging intubations where single-modality methods may fail.