Retrograde intubation with an extraglottic device in place

Background The intubating laryngeal mask airway (ILMA) is an extraglottic device with a high rate of successful ventilation and oxygenation. Most modern airway algorithms suggest using an extraglottic device as the first-line rescue technique for a failed airway in emergency airway management. Eventually, a more secure airway is needed if the extraglottic temporizing device is working well. Retrograde intubation is a surgical airway management technique that is effective but relatively slow, making it most useful when ventilation can be maintained during the procedure. Case Report We report 2 cases of difficult emergency airway management with an ILMA used initially and retrograde intubation later used to establish a more secure airway. Why Should an Emergency Physician Be Aware of This? Retrograde incubation can be performed with an LMA in place for complicated airway management.