Emergency front-of-neck access in cardiac arrest: A scoping review

International Liaison Committee on Resuscitation Advanced Life Support Taskforce

doi:10.1016/j.resplu.2024.100653

Emergency front-of-neck access in cardiac arrest: A scoping review

International Liaison Committee on Resuscitation Advanced Life Support Taskforce

Department of Clinical Medicine - Anaesthesiology and Operation, Intensive care

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Review › Research › peer-review

7 Citations (Scopus)

Abstract

Background: Airway management is a core component of the treatment of cardiac arrest. Where a rescuer cannot establish a patent airway to provide oxygenation and ventilation using standard basic and advanced airway techniques, there may be a need to consider emergency front-of-neck airway access (eFONA, e.g., cricothyroidotomy), but there is limited evidence to inform this approach. Objectives: This scoping review aims to identify the evidence for the use of eFONA techniques in patients with cardiac arrest. Methods: In November 2023, we searched Medline, Embase, and Cochrane Central to identify studies on eFONA in adults. We included randomised controlled trials, non-randomised studies, and case series with at least five cases that described any use of eFONA. We extracted data, including study setting, population characteristics, intervention characteristics, and outcomes. Our analysis focused on four key areas: incidence of eFONA, eFONA success rates, clinical outcomes, and complications. Results: The search identified 21,565 papers, of which 18,934 remained after de-duplication. After screening, we included 69 studies (53 reported incidence, 40 reported success rate, 38 reported clinical outcomes; 36 studies reported complications). We identified only one randomised controlled trial. Across studies, there was a total of 4,457 eFONA attempts, with a median of 31 attempts (interquartile range 16–56.5) per study. There was marked heterogeneity across studies that precluded any pooling of data. There were no studies that included only patients in cardiac arrest. Conclusion: The available evidence for eFONA is extremely heterogeneous, with no studies specifically focusing on its use in adults with cardiac arrest.

Original language	English
Article number	100653
Journal	Resuscitation Plus
Volume	18
ISSN	2666-5204
DOIs	https://doi.org/10.1016/j.resplu.2024.100653
Publication status	Published - Jun 2024

Keywords

Cricothyroidotomy
Emergency front-of-neck access
Endotracheal intubation
Heart arrest
Out-of-hospital cardiac arrest

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@article{b842effeb50346f7b18e45122b5c9ca4,

title = "Emergency front-of-neck access in cardiac arrest: A scoping review",

abstract = "Background: Airway management is a core component of the treatment of cardiac arrest. Where a rescuer cannot establish a patent airway to provide oxygenation and ventilation using standard basic and advanced airway techniques, there may be a need to consider emergency front-of-neck airway access (eFONA, e.g., cricothyroidotomy), but there is limited evidence to inform this approach. Objectives: This scoping review aims to identify the evidence for the use of eFONA techniques in patients with cardiac arrest. Methods: In November 2023, we searched Medline, Embase, and Cochrane Central to identify studies on eFONA in adults. We included randomised controlled trials, non-randomised studies, and case series with at least five cases that described any use of eFONA. We extracted data, including study setting, population characteristics, intervention characteristics, and outcomes. Our analysis focused on four key areas: incidence of eFONA, eFONA success rates, clinical outcomes, and complications. Results: The search identified 21,565 papers, of which 18,934 remained after de-duplication. After screening, we included 69 studies (53 reported incidence, 40 reported success rate, 38 reported clinical outcomes; 36 studies reported complications). We identified only one randomised controlled trial. Across studies, there was a total of 4,457 eFONA attempts, with a median of 31 attempts (interquartile range 16–56.5) per study. There was marked heterogeneity across studies that precluded any pooling of data. There were no studies that included only patients in cardiac arrest. Conclusion: The available evidence for eFONA is extremely heterogeneous, with no studies specifically focusing on its use in adults with cardiac arrest.",

keywords = "Cricothyroidotomy, Emergency front-of-neck access, Endotracheal intubation, Heart arrest, Out-of-hospital cardiac arrest",

author = "Mohammed Aljanoubi and Almazrua, \{Abdulkarim A.\} and Samantha Johnson and Drennan, \{Ian R.\} and Reynolds, \{Joshua C.\} and Jasmeet Soar and Keith Couper and Berg, \{Katherine M.\} and B{\"o}ttiger, \{Bernd W.\} and Chia, \{Yew Woon\} and Conor Crowley and Sonia D'Arrigo and Deakin, \{Charles D.\} and Fernando, \{Shannon M.\} and Rakesh Garg and Asger Granfeldt and Brian Grunau and Hirsch, \{Karen G.\} and Holmberg, \{Mathias J.\} and Eric Lavonas and Carrie Leong and Kudenchuk, \{Peter J.\} and Peter Morley and Ari Moskowitz and Robert Neumar and Nicholson, \{Tonia C.\} and Nikolaos Nikolaou and Nolan, \{Jerry P.\} and Brian O'Neil and Shinichiro Ohshimo and Michael Parr and Helen Pocock and Claudio Sandroni and Tommaso Scquizzato and Markus Skrifvars and Neville Vlok and Michelle Welsford and Carolyn Zelop and \{International Liaison Committee on Resuscitation Advanced Life Support Taskforce\}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2024",

month = jun,

doi = "10.1016/j.resplu.2024.100653",

language = "English",

volume = "18",

journal = "Resuscitation Plus",

issn = "2666-5204",

publisher = "Elsevier B.V.",

}

TY - JOUR

T1 - Emergency front-of-neck access in cardiac arrest

T2 - A scoping review

AU - Aljanoubi, Mohammed

AU - Almazrua, Abdulkarim A.

AU - Johnson, Samantha

AU - Drennan, Ian R.

AU - Reynolds, Joshua C.

AU - Soar, Jasmeet

AU - Couper, Keith

AU - Berg, Katherine M.

AU - Böttiger, Bernd W.

AU - Chia, Yew Woon

AU - Crowley, Conor

AU - D'Arrigo, Sonia

AU - Deakin, Charles D.

AU - Fernando, Shannon M.

AU - Garg, Rakesh

AU - Granfeldt, Asger

AU - Grunau, Brian

AU - Hirsch, Karen G.

AU - Holmberg, Mathias J.

AU - Lavonas, Eric

AU - Leong, Carrie

AU - Kudenchuk, Peter J.

AU - Morley, Peter

AU - Moskowitz, Ari

AU - Neumar, Robert

AU - Nicholson, Tonia C.

AU - Nikolaou, Nikolaos

AU - Nolan, Jerry P.

AU - O'Neil, Brian

AU - Ohshimo, Shinichiro

AU - Parr, Michael

AU - Pocock, Helen

AU - Sandroni, Claudio

AU - Scquizzato, Tommaso

AU - Skrifvars, Markus

AU - Vlok, Neville

AU - Welsford, Michelle

AU - Zelop, Carolyn

AU - International Liaison Committee on Resuscitation Advanced Life Support Taskforce

PY - 2024/6

Y1 - 2024/6

N2 - Background: Airway management is a core component of the treatment of cardiac arrest. Where a rescuer cannot establish a patent airway to provide oxygenation and ventilation using standard basic and advanced airway techniques, there may be a need to consider emergency front-of-neck airway access (eFONA, e.g., cricothyroidotomy), but there is limited evidence to inform this approach. Objectives: This scoping review aims to identify the evidence for the use of eFONA techniques in patients with cardiac arrest. Methods: In November 2023, we searched Medline, Embase, and Cochrane Central to identify studies on eFONA in adults. We included randomised controlled trials, non-randomised studies, and case series with at least five cases that described any use of eFONA. We extracted data, including study setting, population characteristics, intervention characteristics, and outcomes. Our analysis focused on four key areas: incidence of eFONA, eFONA success rates, clinical outcomes, and complications. Results: The search identified 21,565 papers, of which 18,934 remained after de-duplication. After screening, we included 69 studies (53 reported incidence, 40 reported success rate, 38 reported clinical outcomes; 36 studies reported complications). We identified only one randomised controlled trial. Across studies, there was a total of 4,457 eFONA attempts, with a median of 31 attempts (interquartile range 16–56.5) per study. There was marked heterogeneity across studies that precluded any pooling of data. There were no studies that included only patients in cardiac arrest. Conclusion: The available evidence for eFONA is extremely heterogeneous, with no studies specifically focusing on its use in adults with cardiac arrest.

AB - Background: Airway management is a core component of the treatment of cardiac arrest. Where a rescuer cannot establish a patent airway to provide oxygenation and ventilation using standard basic and advanced airway techniques, there may be a need to consider emergency front-of-neck airway access (eFONA, e.g., cricothyroidotomy), but there is limited evidence to inform this approach. Objectives: This scoping review aims to identify the evidence for the use of eFONA techniques in patients with cardiac arrest. Methods: In November 2023, we searched Medline, Embase, and Cochrane Central to identify studies on eFONA in adults. We included randomised controlled trials, non-randomised studies, and case series with at least five cases that described any use of eFONA. We extracted data, including study setting, population characteristics, intervention characteristics, and outcomes. Our analysis focused on four key areas: incidence of eFONA, eFONA success rates, clinical outcomes, and complications. Results: The search identified 21,565 papers, of which 18,934 remained after de-duplication. After screening, we included 69 studies (53 reported incidence, 40 reported success rate, 38 reported clinical outcomes; 36 studies reported complications). We identified only one randomised controlled trial. Across studies, there was a total of 4,457 eFONA attempts, with a median of 31 attempts (interquartile range 16–56.5) per study. There was marked heterogeneity across studies that precluded any pooling of data. There were no studies that included only patients in cardiac arrest. Conclusion: The available evidence for eFONA is extremely heterogeneous, with no studies specifically focusing on its use in adults with cardiac arrest.

KW - Cricothyroidotomy

KW - Emergency front-of-neck access

KW - Endotracheal intubation

KW - Heart arrest

KW - Out-of-hospital cardiac arrest

UR - https://www.scopus.com/pages/publications/85192072166

U2 - 10.1016/j.resplu.2024.100653

DO - 10.1016/j.resplu.2024.100653

M3 - Review

C2 - 38716381

AN - SCOPUS:85192072166

SN - 2666-5204

VL - 18

JO - Resuscitation Plus

JF - Resuscitation Plus

M1 - 100653

ER -

Emergency front-of-neck access in cardiac arrest: A scoping review

Abstract

Keywords

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