If extraglottic/ETT placement is unsuccessful and you cannot ventilate without an extraglottic/ETT, which procedure should be performed?

• A. Nasal airway
• B. Laryngoscopy
• C. Tracheostomy
• D. Cricothyrotomy

Answer: (D)

When you cannot ventilate after attempting an extraglottic device and you’ve effectively failed to secure the airway with noninvasive means, you must establish a definitive airway quickly. In the field, the fastest and most reliable surgical option is cricothyrotomy. This procedure creates a direct airway by entering through the cricothyroid membrane, bypassing obstructions in the upper airway and allowing immediate ventilation.

A tracheostomy is more complex and time-consuming, not ideal in an emergent situation. A nasal airway or attempting another laryngoscopy won’t provide the rapid, secure airway needed when ventilation is not possible with the current approach.