Critical care paramedics’ experiences of performing an emergency scalpel cricothyroidotomy: a qualitative study

Abstract

Introduction: A scalpel cricothyroidotomy or front of neck access (FONA) is a rarely performed part of airway management for when other steps have failed and the patient cannot be intubated or ventilated. Increasingly advanced and specialist paramedics are being trained to perform this procedure within the pre-hospital environment.Methods: Advanced and specialist paramedics within a UK ambulance service that had performed a FONA were invited to participate in this qualitative research. Semi-structured interviews were used to gather information on the participants’ experiences. This information underwent thematic analysis to develop codes which were then grouped into themes.Results: Seven participants were interviewed between December 2020 and January 2021. Three main themes were identified: the procedure, isolation and training. The main complications described were bleeding in excess of expectations, moving structures, surgical emphysema and a false track.Conclusion: Complications appeared common; training to perform a FONA should include complications and an approach to their management similar to other airway management procedures. Isolation was a common theme within this study, however remote support from a peer appeared beneficial.

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

“…Recent qualitative research with UK critical care paramedics described the stress associated with making a decision to perform eFONA. 81 Our review findings provide reassurance that when appropriately skilled healthcare providers attempt eFONA, the success rate is usually high in all clinical settings, although index studies rarely provided information on provider training or exposure to eFONA. There is a need for further studies that report the incidence, success rate, and outcomes of patients in cardiac arrest that receive eFONA.…”