eFONA – a Training Video

In this video produced by the Difficult Airway Society (DAS), you will see a demonstration of how to perform an emergency Front of Neck Airway (eFONA) using a “scalpel-bougie-tube” technique. This is based on the 2015 DAS Guidelines for Unanticipated Difficult Intubation recommending the use of scalpel cricothyroidotomy as the fastest and most reliable method of securing the airway in the emergency setting.

A cuffed tube in the trachea protects the airway from aspiration, provides a secure route for exhalation, allows low-pressure ventilation using standard breathing systems, and permits end-tidal CO2 monitoring.

The optimal technique for emergency front of neck airway (eFONA) is still subject of great debate in the medical community. Other techniques are described and practiced, such as cannula techniques (narrow-bore (<4 mm) cannula or wide-bore cannula over guide-wire, non-Seldinger wide-bore cannula) but are not described here. The multitude of commercially available devices presents a problem because familiarity with equipment that is not universally available makes it harder to standardise training. We recommend that clinicians undergo regular training, to maintain familiarity and skills in whichever locally adopted technique.

Of note is the work of Dr Andy Heard, who pioneered the standardisation of training and equipment for two eFONA approaches, that is now common place in Australia. You can read this article or watch these Youtube videos for further information.

In Week 1 Professor Tim Cook explained that it is important for the institution and the individual to be prepared. More important than focusing on the actual technique for eFONA is for institutions to adopt formal guidelines, ensure that staff are adequately trained and that equipment is readily available and clearly signposted. Individual clinicians must ensure that they are familiar with the institution’s guidelines, know where to find the equipment in an emergency and train to become skilled in the technique adopted by the institution.

The Airway App

Although individual clinicians rarely have to undertake this procedure, hundreds are performed annually on a global level. The Airway App designed and developed by Dr Laura Duggan, Canada, is an open access, international collaboration collecting data rendered by clinicians who have performed eFONA. Results are updated regularly and track success with different techniques. If you have performed eFONA, consider contributing to this global database! You can read more about the Airway App in this article

What technique is taught and what equipment is available in your place of work? What were the reasons behind the choice? Share your experience in the discussion here below