• Br J Anaesth · May 2023

    Review Meta Analysis

    Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis.

    • Sarah Morton, Pascale Avery, Justin Kua, and Matt O'Meara.
    • Essex and Herts Air Ambulance, Colchester, UK; Imperial College London, London, UK. Electronic address: sarah.morton@doctors.org.uk.
    • Br J Anaesth. 2023 May 1; 130 (5): 636644636-644.

    BackgroundFront-of-neck access (FONA) is an emergency procedure used as a last resort to achieve a patent airway in the prehospital environment. In this systematic review with meta-analysis, we aimed to evaluate the number and success rate of FONA procedures in the prehospital setting, including changes since 2017, when a surgical technique was outlined as the first-line prehospital method.MethodsA systematic literature search (PROSPERO CRD42022348975) was performed from inception of databases to July 2022 to identify studies in patients of any age undergoing prehospital FONA, followed by data extraction. Meta-analysis was used to derive pooled success rates. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.ResultsFrom 909 studies, 69 studies were included (33 low quality; 36 very low quality) with 3292 prehospital FONA attempts described (1229 available for analysis). The crude median success rate increased from 99.2% before 2017 to 100.0% after 2017. Meta-analysis revealed a pooled overall FONA success rate of 88.0% (95% confidence interval [CI], 85.0-91.0%). Surgical techniques had the highest success rate at a median of 100.0% (pooled rate=92.0%; 95% CI, 88.0-95.0%) vs 50.0% for needle techniques (pooled rate=52.0%; 95% CI, 28.0-76.0%).ConclusionsDespite being a relatively rare procedure in the prehospital setting, the success rate for FONA is high. A surgical technique for FONA appears more successful than needle techniques, and supports existing UK prehospital guidelines.Systematic Review ProtocolPROSPERO CRD42022348975.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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