What is the recommended action if a definitive airway cannot be secured after two ETT attempts?

In the scenario where a definitive airway cannot be secured after two attempts with an endotracheal tube (ETT), the recommended action is to insert a King Tube, which is a type of supraglottic airway device. The King Tube is designed to establish a patent airway in situations where intubation has failed.

This device allows for ventilation and oxygenation, bypassing the traditional difficulties of securing an airway through the oral route with an ETT. It provides a critical alternative by creating a seal in the esophagus and facilitating passive ventilation through the pharynx. This is particularly valuable in emergencies when time is of the essence and successful oxygenation is paramount.

While administering high-flow oxygen can be beneficial in certain contexts, it does not address the fundamental problem of securing an airway, which is necessary for effective respiratory support. The insertion of a tracheostomy tube is generally reserved for longer-term ventilation needs and is more invasive, which is not ideal in an emergency situation where immediate airway management is required. Continuing attempts with the ETT might lead to further complications or trauma without guaranteeing success, especially after two unsuccessful attempts. Therefore, using a King Tube offers a practical and effective solution in this critical situation.