Ultrasound-guided retrograde emergency intubation : Life-saving management of a bleeding airway emergency with unclear anatomical situation

Abstract

The technique of ultrasound-guided retrograde intubation is a less invasive procedure for airway management especially in an emergency situation with massive bleeding. This article describes a case of postoperative neck bleeding into the pharynx and neck leading to significant anatomical impairment combined with laryngeal obstruction that was successfully managed using this technique in a modified way. Anatomically non-palpable from a superficial approach, conventional cricotomy and awake tracheotomy were not possible and attempts of fiber optic intubation failed; therefore, ultrasound-guided tracheal puncture was used to advance a conventional central line guidewire towards and out of the mouth and to install orotracheal intubation via a Cook airway catheter cut in half which was advanced over the wire. All airway material remained in place in order to secure the airway until permanent tracheostomy was established along the wire entrance. Sufficient ventilation was possible with the Cook catheter and wire still in the tube. No hypoxic episodes occurred and the patient achieved full recovery.