Failed Attempt / Difficult Airway

After every failed attempt, change a meaningful variable and escalate early.

Airway Checklist: This static page supports simulation, prebriefing, and source review. It does not save encounter state, analyze a patient, or generate a clinical directive.

Discussion points

After each failed attempt - change one variable

Device
Operator
Positioning
Technique

Escalation

Call for help
Activate DART or the local difficult-airway response
Place a supraglottic airway when appropriate
Proceed to surgical airway if CICO

Teaching pearls

A second attempt should not be a replay of the first. Make the next attempt meaningfully different and keep oxygenation as the priority.
Simulation discussion prompt: The attempt failed. The current failure mode is __. For the next move we are changing __. Help is coming. Backup oxygenation is __. If we cannot intubate and cannot oxygenate, we move to surgical airway.

Common pitfalls for discussion

Repeating the same device, operator, position, and technique
Failure to call for help early
Continuing attempts while oxygenation deteriorates
Delaying supraglottic backup or front-of-neck access in CICO
Using DART language without defining the local equivalent

About this resource

Created by: Kyle Brown MD; Andrew Pirotte, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: EM faculty Reviewed: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu