It was the first time in 100 years that a nominee for House speaker could not take the gavel on the first vote, but McCarthy has vowed to fight to the finish.
The deeply riven US House of Representatives has been engulfed in crisis for a second day running as fresh rounds of voting failed to produce a winner in the race for speaker.
Conservative hardliners have been blocking establishment pick Kevin McCarthy in a humiliating string of ballots that have paralysed the lower chamber of Congress since it flipped to narrow Republican control after the new year.
The Californian former entrepreneur failed to secure the gavel for a sixth time on Wednesday as his path was barred by an emboldened faction of right-wingers, who have made history by pushing a speakership race past the first ballot for the first time in a century.
For a fourth, fifth and sixth time, Republicans tried to vote McCarthy into the top job as the House plunged deeper into disarray. But the votes were producing almost the same outcome, 20 conservative holdouts still refusing to support him, and leaving him far short of the 218 typically needed to win the gavel.
The debacle — described by President Joe Biden as "embarrassing" — has left the chamber unable to swear in members, fill committees, adopt rules for legislating, or negotiate a path through the paralysis.
McCarthy — who has raised millions of dollars to elect right-wing lawmakers — dragged his party back to a 222-212 House majority in last year's midterms after four years in the wilderness.
The 57-year-old has long coveted the opportunity to replace Democrat Nancy Pelosi, something of an icon in US politics who held the gavel in the last Congress.
READ MORE: Right-wing rebels sabotage McCarthy's speaker bid in US Congress
Deal could be struck to end deadlock
The speaker standoff sparked frantic behind-the-scenes negotiations as McCarthy's allies sought to cut a deal with his conservative detractors that could also win the approval of moderates.
He told reporters in Congress he planned to stay in the race and had spoken to his biggest VIP backer, Donald Trump, who was still supporting his candidacy.
Republican Lauren Boebert, a firm Colorado conservative, nominated Republican Byron Donalds, R-Fla, the chosen protest candidate of the day — and called for Trump, the conservatives' hero, to tell McCarthy, "Sir, you do not have the votes, and it's time to withdraw."
Earlier on Wednesday, Trump had done the opposite, urging Republicans to vote for McCarthy.
"Close the deal, take the victory," he wrote on his social media site, using all capital letters. "Do not turn a great triumph into a giant & embarrassing defeat."
No House business can take place without a speaker, meaning the chamber has to continue voting until someone wins a majority.
But there was little sign that any deal could be struck to end the deadlock as members prepared to hunker down for a long, repetitive series of ballots.
McCarthy, who has been bleeding support and has lost every round to Democratic minority leader Hakeem Jeffries, will be under pressure to reverse the momentum if he stays in the race quickly.
Should he decide it's too steep a hill to climb, the two parties are likely to start casting around for a "unity" candidate — a consensus Republican who commits to being as bipartisan as possible.
It was the first time in 100 years that a nominee for House speaker could not take the gavel on the first vote, but McCarthy appeared undeterred.
Instead, he vowed to fight to the finish.
READ MORE: US Republican Kevin McCarthy struggles for support ahead of speaker vote
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