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Chapter 20 - Front of Neck Airway (FONA)

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Conventional airway management, including intubation and the various modes of lung ventilation, is usually successful. When it fails (cannot intubate, cannot ventilate/oxygenate) it is a life-threatening emergency and will lead to hypoxic brain damage in a few minutes, followed by death, if not resolved. The common final pathway for securing the airway and oxygenation is an emergency front of neck airway (eFONA). Immediate action with a clear plan, appropriate equipment and skills is essential. The ability to efficiently perform an eFONA is a fundamental requirement for any practitioner engaged in advanced airway management. Many techniques are described and it is a difficult area to study, so the evidence of superiority of one technique over others is hard to establish. Preparation, in terms of equipment availability, procedural practice, team familiarity and prompt transitioning through the algorithm when other techniques fail, is important for patient safety. These human factors aspects of eFONA management are at least as important as the procedural technique chosen. This chapter considers the risk factors for airway failure and management of the cannot intubate, cannot oxygenate situation and eFONA procedure in adults and children.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Duggan, LV, Ballantyne Scott, B, Law, JA, et al. (2016). Transtracheal jet ventilation in the ‘can’t intubate can’t oxygenate’ emergency: a systematic review. British Journal of Anaesthesia, 117(Suppl 1), i28i38.CrossRefGoogle ScholarPubMed
Duggan, LV, Lockhart, SL, Cook, TM, et al. (2018). The Airway App: exploring the role of smartphone technology to capture emergency front-of-neck airway experiences internationally. Anaesthesia, 73, 703710.CrossRefGoogle ScholarPubMed
Frerk, C, Mitchell, VS, McNarry, AF, et al. (2015). Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. British Journal of Anaesthesia, 115, 827848.CrossRefGoogle Scholar
Johansen, K, Holm-Knudsen, RJ, Charabi, B, Kristensen, MS, Rasmussen, LS. (2010). Cannot ventilate-cannot intubate an infant: surgical tracheotomy or transtracheal cannula? Paediatric Anaesthesia, 20, 987993.Google Scholar
Kristensen, MS, Teoh, WH, Baker, PA. (2015). Percutaneous emergency airway access; prevention, preparation, technique and training. British Journal of Anaesthesia, 114, 357361.CrossRefGoogle ScholarPubMed
Law, JA. (2016). Deficiencies in locating the cricothyroid membrane by palpation: we can’t and the surgeons can’t, so what now for the emergency surgical airway? Canadian Journal of Anaesthesia, 63, 791796.CrossRefGoogle ScholarPubMed
Peterson, GN, Domino, KB, Caplan, RA, et al. (2005). Management of the difficult airway: a closed claims analysis. Anesthesiology, 103, 3339.CrossRefGoogle ScholarPubMed

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