What procedure should be used when the airway cannot be effectively managed by other means?

When the airway cannot be effectively managed by other methods, the surgical airway procedure is employed as a definitive solution. This approach is utilized in critical situations where conventional airway management techniques, such as bag-valve-mask ventilation or non-invasive positive pressure ventilation, have failed or are deemed impossible due to factors like severe facial trauma, obstruction, or swelling.

A surgical airway allows for direct access to the trachea, ensuring that air can be delivered to the lungs and that the patient's oxygenation is maintained. Commonly, this procedure involves creating an opening through the skin into the trachea, often through a technique known as cricothyrotomy or tracheostomy, depending on the scenario and the urgency of the situation.

In contrast, non-invasive positive pressure ventilation might not be suitable for all patients, especially if there is significant facial trauma or obstruction. Needle decompression is specifically aimed at relieving tension pneumothorax and does not address airway management directly. Manual ventilation techniques, while helpful in many situations, may also be ineffective if the airway control is compromised.

Thus, the surgical airway procedure is critical in emergencies where other airway management methods have failed, making it the appropriate choice in such scenarios.