If endotracheal intubation is unsuccessful, which device is indicated next?

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When endotracheal intubation cannot be achieved, the priority becomes maintaining ventilation with a rapid-to-insert rescue airway. A supraglottic airway fits this role because it sits above the vocal cords and can be placed quickly with less skill and time than a definitive airway. It creates a seal that allows effective ventilation and oxygenation while you re-evaluate the situation, optimize technique, reposition, or prepare for another intubation attempt or a definitive airway.

This option is favored over continuing with just a nasal cannula, which cannot provide controlled ventilation or airway protection, and over pushing ahead with another blind or difficult intubation attempt without a rescue airway. It’s also distinct from the endotracheal tube itself—the goal here is a fast, reliable bridge to secure ventilation when intubation has failed, rather than forcing a repeat attempt without a backup plan.