Chapter 20 - Front of Neck Airway (FONA)

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.