Emergency front-of-neck access (eFONA) is one of the most feared clinical interventions any of us is likely to face. Unfortunately, current evidence does not seem to provide enough guidance as to what is the most effective way of dealing with the dreaded can’t intubate can’t oxygenate scenario.
In this study, Rees et al have compared cannula and scalpel-bougie eFONA techniques using time to oxygen delivery as their primary outcome. The value of this study is, perhaps, not as much in the main findings as it is in the analysis of failures and repeated attempts. Rees et al. found that the participants had lower odds of failure using cannula (one failure) than using scalpel – bougie technique (15 failures).
Knowing how and why failures happen can be invaluable and is likely to help individual anaesthetist make a more informed decision about what eFONA technique is likely to suit better their clinical environment and skill mix. Well worth reading.
Rees KA, O’Halloran LJ, Wawryk JB, Gotmaker R, Cameron EK, Woonton HDJ: Time to oxygenate for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model. Anaesthesia 2019; Early View.