A scoping review of emergency front of neck access (eFONA) for airway access in the setting of trauma

Background: Emergency front of neck access (eFONA) is an emergent procedure performed in “cannot intubate, cannot ventilate” scenarios to establish a patent airway that was otherwise compromised. We sought to describe the recent literature on eFONA. Methods: We conducted a scoping review using the PRISMA-ScR Checklist to provide comprehensive summary of the most relevant eFONA literature over topics such as civilian and military incidence and outcome, available techniques, the use of ultrasound in performing eFONA, training data, complications and contraindications, and emerging data on the procedure. Additionally, knowledge gaps were identified that would benefit from further study. We used PubMed and Google Scholar to identify eFONA literature from 2001 to 2024. Results: We identified 89 English studies for this analysis –retrospective studies (n = 35) were most frequent followed by, comparative studies (n = 17), and randomized controlled trials (n = 14). Of the studies analyzed, 86 were original research studies. The papers used came from journals and registries worldwide to provide an accurate representation of in many emergency settings. Conclusions: Our findings suggest that eFONA remains a rare procedure, but when performed by clinicians with sufficient practice, it can be a successful airway management strategy. Areas that would benefit from more research include identifying the types of eFONA used in the prehospital and emergency settings, including additional exploration of surgical and needle techniques along with skills attainment and sustainment.