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The Two-Hand Approach to Retrograde Intubation
Armaan Chokshi1, Jyothika Annareddy1, Amit Aggarwal1
1Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, USA.
Cureus
|November 26, 2025
Summary
Retrograde intubation, a valuable airway rescue technique, bypasses vocal cord visualization for difficult airways. A two-hand modification improves stabilization and reduces complications during endotracheal tube placement.
Area of Science:
- Anesthesiology
- Emergency Medicine
- Airway Management
Background:
- Retrograde intubation is an underutilized, minimally invasive airway rescue technique.
- It bypasses direct vocal cord visualization, useful in difficult airway scenarios.
- Standard technique involves guidewire passage through the cricothyroid membrane.
Purpose of the Study:
- To describe a two-hand modification of retrograde intubation.
- To address catheter dislodgement challenges in the standard technique.
- To enhance the reliability and success rate of retrograde intubation.
Main Methods:
- A two-hand modification was developed to stabilize the endotracheal tube and airway exchange catheter.
- This technique involves stabilizing the ETT at the nares with one hand and the catheter with the other.
- Utilizes simple equipment and common anatomical landmarks.
Main Results:
- The two-hand modification improves stabilization of the airway exchange catheter.
- It minimizes displacement during guidewire and catheter withdrawal.
- Reduces complications and increases success rates in difficult airway management.
Conclusions:
- The two-hand modification makes retrograde intubation a reliable, lifesaving technique.
- It offers improved stabilization and reduced complications compared to the standard method.
- This approach is efficient for emergency or resource-limited settings.
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