# Emergency surgical airway experience from an Australian major trauma centre emergency department

## TL;DR

Emergency front of neck access is a rare but life-saving procedure, performed once every 2 years in a major trauma center.

## Contribution

The study provides real-world data on eFONA frequency and clinician experience in a major trauma center.

## Key findings

- eFONA was performed in 0.22% of intubated patients over 8 years.
- All eFONA procedures were successfully completed by clinicians with prior cadaver training.
- EPs performed 24 surgical airways in 768 years of consultant-level experience.

## Abstract

Emergency front of neck access (eFONA) may be life-saving in the can’t intubate can’t oxygenate scenario but the frequency with which an individual emergency department (ED) or emergency physician (EP) will be required to perform this intervention is very low.

Identify and describe all eFONA cases from the Alfred Airway Registry and to estimate the per clinician incidence of the procedure.

Retrospective case series of all eFONA cases from the Alfred Airway Registry. Data on all intubations undertaken in the ED were collected prospectively from February 2017 to January 2025. Data on individual clinician experience of eFONA was captured by an electronic survey.

Of the 1805 patients intubated during the 8 years study period, 4 cricothyroidotomies were performed (0.22%) with a scalpel-finger-bougie-tube technique. All were performed outside daytime hours (08:00–18:00) and all were successfully completed by clinicians who had previously practiced the procedure on a cadaver. 75% were in trauma patients, 75% were male and 75% were performed by emergency medicine doctors. From the survey data EPs performed 24 surgical airways in 768 years of consultant-level experience.

eFONA is a rare intervention occurring approximately once every 2 years in this trauma centre ED, and once every 32 years of consultant-level experience for the centre’s EPs. The scalpel-finger-bougie-tube technique reliable achieved a secure airway in these patients.