Originally posted in my Facebook community page #TBayAirBasedRounds
More to add regarding bougie for this too
Optimizing position
Right paraglossal straight blade
VL but minimize hyperangulated approach and hyperangulated styletting/bougie
Scope via SGA
Bougie via rigid suction (HT @jducanto see below) or VL/IL channel or CMAC left side channel
Surgical is your last resort (actually ECMO is?)
airwayNautics 
Scope via SGA is the best approach for the limited space scenario.
Placing a bougie through a suction catheter can also be a game-changer (the suction catheter is small relative to the size of a tracheal tube, is rigid like a rigid stylet, and delivers a bougie by guiding it around a tighter corner than it is capable of traversing on its own). This is a technique called ‘SAACI’–Suction-Assisted-Airway-Catheter-Insertion.
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The bougie can also go around the tight corner by using the channeled indirect laryngoscopes like Airtraq or King Vision either within the channel or via the ETT preloaded within the channel. The CMAC video laryngoscope blades come with an option to have a small diameter left channel. It is meant for oxygen or suction catheters but it can also accomodate the bougie to guide it around the corner.
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