title: Is retrograde intubation more successful than direct laryngoscopic technique in difficult endotracheal intubation?
abstract: BACKGROUND
  Difficult airway intubation is an emergency condition both at the emergency department (ED) and in out-of-hospital situations. Retrograde intubation (RI) is another option for difficult airway management. There are limited data regarding the successful rate of RI compared with direct laryngoscopy (DL) intubation, the commonly used method in the ED.
  
  
  METHODS
  This study was a randomized, controlled trial. Participants were randomly assigned to either the RI or the DL technique to attempt intubation on a difficult airway mannequin (Cormack and Lehane grades 3-4). First, all participants received the training on the RI or DL, and then attempted intubation. After the training, the participants had 2 chances to intubate. The outcomes of this study included numbers of participants who successfully intubated and times of successful intubation.
  
  
  RESULTS
  There were 100 participants in this study, with 50 participants in each group (RI and DL). There was no significant difference between the groups in terms of experience at the ED or DL. The successful rate of intubation was significantly higher in the RI group than in the DL group (74% vs 12%; P = .001), as was the rate of successful intubation on the first attempt (34% vs 8%; P = .026). There were no statistical differences between physicians and medical students in any of the 3 outcomes in either the DL or RI group.
  
  
  CONCLUSIONS
  The RI technique had a higher success rate in difficult airway intubation than the DL technique, regardless of experience.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand.
authors.forename: Pitsucha
authors.initials: P
authors.lastname: Sanguanwit
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand.
authors.forename: Thavinee
authors.initials: T
authors.lastname: Trainarongsakul
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand.
authors.forename: Noppanan
authors.initials: N
authors.lastname: Kaewsawang
authors.affiliation: Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand; Internal Medicine Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Kittisak
authors.initials: K
authors.lastname: Sawanyawisuth
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand. Electronic address: yuwares.sit@mahidol.ac.th.
authors.forename: Yuwares
authors.initials: Y
authors.lastname: Sitthichanbuncha
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008348:Manikins; D010820:Physicians; D013337:Students, Medical; D013785:Thailand; D055815:Young Adult