If you are unable to place the extraglottic/ETT and cannot ventilate without them, what is the next step?

• A. Cricothyroidotomy
• B. Tracheostomy
• C. Needle cricothyrotomy
• D. Bag-valve mask only

Answer: (A)

When you cannot place an airway device and cannot ventilate, the next step is to establish a definitive airway quickly by performing a cricothyroidotomy. This surgical airway going through the cricothyroid membrane provides direct access to the trachea, bypassing obstructions above the larynx and allowing effective ventilation in an emergency.

Tracheostomy is more time-consuming and technically complex, making it impractical as the immediate move in an acute inability to ventilate. A needle cricothyrotomy can be used as a temporary bridge in some settings, but it often provides unreliable ventilation in adults and is not the preferred definitive approach when a surgical airway is available. Relying on a bag-valve mask only won’t work once ventilation cannot be achieved with noninvasive means, so securing a surgical airway is the appropriate next step.