Performance of emergency surgical front of neck airway access by head and neck surgeons, general surgeons, or anaesthetists: an in situ simulation study

BACKGROUND The “Can’t Intubate Can’t Oxygenate” (CICO) emergency requires urgent front of neck airway access to prevent death. In cases reported to the 4th National Audit Project, the most successful front of neck airway (FONA) was a surgical technique, almost all of which were performed by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be unwilling to perform an emergency surgical FONA. AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully execute emergency surgical FONA faster than anaesthetists and general surgeons.

METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an in-situ hi-fidelity simulation of an ‘anaesthetic emergency’. Participants were not told in advance that this would be a CICO scenario.

RESULTS There was no significant difference in total time to successful ventilation between the three groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists still believed ‘surgeons’ best placed to perform emergency surgical FONA in a genuine CICO situation.

CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at levels comparable to head and neck surgeons and should feel empowered to lead this procedure in the event of a CICO emergency.