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Secured airway is a must in spontaneous or assisted ventilation. A variety of methods are in clinical use for establishing an airway, of which endotracheal intubation is the most common. Difficulties in establishing a secured airway may deteriorate to a serious, and even a life-threatening situation. The management of difficult airways indicates the use of advanced, urgent means, and may lead to surgical intervention. This article describes an alternative technique for tracheal intubation, useful in such cases. Retrograde tracheal intubation is carried out by percutaneous insertion of a needle into the trachea in the subglotic region, passing a guidewire through the needle cephaled until it exits the mouth or nose and threading an endotracheal tube over the guidewire into the trachea. This technique is relatively easy and safe, and should be considered in difficult airway management.