In trauma airway management when endotracheal intubation fails, which option is considered a last-resort procedure?

• A. Nasal cannula oxygen therapy
• B. Supraglottic airway device
• C. Cricothyrotomy
• D. Wait for evacuation

Answer: (C)

When airway failure in trauma is at stake, the first goal is to rapidly secure ventilation. If endotracheal intubation cannot be achieved and cannot be promptly established with noninvasive methods, a surgical airway becomes the last-resort option to guarantee oxygen delivery. Cricothyrotomy provides direct access to the trachea through the cricothyroid membrane, bypassing obstructions or injuries in the upper airway and enabling quick ventilation. This immediacy is crucial in life-threatening scenarios where delays endanger the patient’s oxygen supply.

Nasal cannula oxygen therapy, while useful for supplemental oxygen, does not provide a real rescue airway or ventilation and cannot reverse a failed intubation with ongoing hypoxia. A supraglottic airway device can serve as a bridge to help ventilation, but in many trauma cases—especially with facial or neck injuries or complex airway disruption—it may be unreliable or insufficient. Waiting for evacuation postpones necessary airway security and risks further deterioration.