PMID- 33179449
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231129
IS  - 1742-6723 (Electronic)
IS  - 1742-6723 (Linking)
VI  - 33
IP  - 3
DP  - 2021 Jun
TI  - Case series and review of emergency front-of-neck surgical airways from The 
      Australian and New Zealand Emergency Department Airway Registry.
PG  - 499-507
LID - 10.1111/1742-6723.13678 [doi]
AB  - BACKGROUND: An emergency front-of-neck access (eFONA), also called can't 
      intubate, can't oxygenate (CICO) rescue, is a rare event. Little is known about 
      the performance of surgical or percutaneous airways in EDs across Australia and 
      New Zealand. OBJECTIVE: To describe the management of cases resulting in an 
      eFONA, and recorded in The Australian and New Zealand Emergency Department Airway 
      Registry (ANZEDAR). METHODS: A retrospective case series and review of ED 
      patients undergoing surgical or percutaneous airways. Data were collected 
      prospectively over 60 months between 2010 and 2015 from 44 participating EDs. 
      RESULTS: An eFONA/CICO rescue airway was performed on 15 adult patients: 14 
      cricothyroidotomies (0.3% of registry intubations) and one tracheostomy. The 
      indication for intubation was 60% trauma and 40% medical aetiologies. The 
      intubator specialty was emergency medicine in eight (53.3%) episodes. Thirteen 
      (86.7%) cricothyroidotomies and the sole tracheostomy (6.7%) were performed at 
      major referral hospitals with 12 (80%) surgical airways out of hours. In four 
      (26.7%) cases, cricothyroidotomy was performed as the primary intubation method. 
      Pre-oxygenation techniques were used in 14 (93.3%) episodes; apnoeic oxygenation 
      in four (26.7%). CONCLUSIONS: Most cases demonstrated deviations from standard 
      difficult airway practice, which may have increased the likelihood of performance 
      of a surgical airway, and its increased likelihood out of hours. Our findings may 
      inform training strategies to improve care for ED patients requiring this 
      critical intervention. We recommend further discussion of proposed standard 
      terminology for emergency surgical or percutaneous airways, to facilitate clear 
      crisis communication.
CI  - (c) 2020 Australasian College for Emergency Medicine.
FAU - Alkhouri, Hatem
AU  - Alkhouri H
AUID- ORCID: 0000-0002-5569-704X
AD  - Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South 
      Wales, Australia.
AD  - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, 
      Australia.
AD  - The Simpson Centre for Health Services Research (SWS Clinical School), The 
      University of New South Wales, Ingham Institute of Applied Medical Research, 
      Sydney, New South Wales, Australia.
FAU - Richards, Clare
AU  - Richards C
AD  - Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South 
      Wales, Australia.
AD  - Emergency Department, Gosford Hospital, Gosford, New South Wales, Australia.
FAU - Miers, James
AU  - Miers J
AUID- ORCID: 0000-0001-6652-6353
AD  - Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South 
      Wales, Australia.
AD  - Emergency Department, Liverpool Hospital, Sydney, New South Wales, Australia.
FAU - Fogg, Toby
AU  - Fogg T
AD  - Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, 
      Australia.
AD  - CareFlight, Sydney, New South Wales, Australia.
FAU - McCarthy, Sally
AU  - McCarthy S
AUID- ORCID: 0000-0001-7367-8232
AD  - Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South 
      Wales, Australia.
AD  - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, 
      Australia.
AD  - Emergency Department, Prince of Wales Hospital, Sydney, New South Wales, 
      Australia.
LA  - eng
GR  - NSW Agency for Clinical Innovation/
PT  - Journal Article
DEP - 20201111
PL  - Australia
TA  - Emerg Med Australas
JT  - Emergency medicine Australasia : EMA
JID - 101199824
SB  - IM
OTO - NOTNLM
OT  - airway complication
OT  - airway registry
OT  - can't intubate, can't oxygenate rescue
OT  - cricothyroidotomy
OT  - emergency front-of-neck access
OT  - surgical airway
EDAT- 2020/11/13 06:00
MHDA- 2020/11/13 06:01
CRDT- 2020/11/12 05:49
PHST- 2020/10/12 00:00 [revised]
PHST- 2020/08/20 00:00 [received]
PHST- 2020/10/16 00:00 [accepted]
PHST- 2020/11/13 06:01 [medline]
PHST- 2020/11/13 06:00 [pubmed]
PHST- 2020/11/12 05:49 [entrez]
AID - 10.1111/1742-6723.13678 [doi]
PST - ppublish
SO  - Emerg Med Australas. 2021 Jun;33(3):499-507. doi: 10.1111/1742-6723.13678. Epub 
      2020 Nov 11.