Retrograde intubation is planned for a patient in whom both laryngoscopy and supraglottic device placement have failed while spontaneous ventilation continues. Through which structure is the guidewire introduced to exit from the mouth or nose?

• A Thyroid cartilage, above the vocal cords
• B Cricothyroid membrane ✓
• C Cricotracheal ligament between cricoid and first tracheal ring
• D Second intertracheal space below the second ring

Explanation

In retrograde intubation, a needle is inserted through the cricothyroid membrane in the midline, directed cephalad, and a guidewire is threaded upward through the glottis to exit the mouth or nose. An endotracheal tube is then railroaded over the wire antegrade into the trachea. Puncture above the cords risks vocal cord injury, while more caudal sites such as the cricotracheal ligament make the wire harder to retrieve orally and increase the risk of vascular injury. The cricothyroid membrane is superficial, largely free of vessels, and lies directly below the glottis.

Reference: Benumof and Hagberg's Airway Management, 3rd ed.

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Written and medically reviewed by the StethoPrep medical team.