In the event of an unsuccessful ETT attempt:

• Insert OPA and ventilate with 100% oxygen for at least 1 minute. Monitor SpO₂.
• The most experienced, current or appropriate officer MUST be undertaking the intubation
• Re-attempt intubation ONLY if it is absolutely necessary. Change at least one thing e.g. position/operator/stylet/bougie etc. to optimise successful pass.

• Try to confirm tracheal placement:

  • ---

  • CONFIRMED:
    • Continue management in accordance with relevant CPG (end of failed intubation drill).

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  • UNABLE TO CONFIRM:
    • Immediately remove ETT; insert OPA/NPA and ventilate

    • Determine if able to ventilate oxygenate:

      • ---

      • NO:
        • Surgical cricothyrotomy (end of failed intubation drill).

        ---

      • YES:
        • Consider use of a supraglottic device OR whether manual airway control with BVM/OPA is adequate
        • Continue management in accordance with relevant CPG (end of failed intubation drill).