The Evolution of Emergency Front of Neck Access: A Historical Review

Airway patency loss causes acute deoxygenation and carbon dioxide clearance failure and requires immediate intervention to prevent death. When less-invasive airway management approaches and technologies fail, the rescue algorithm end point is emergency front of neck access (eFONA), a high-risk, low-frequency intervention necessitating specialized training and regular skill maintenance. The historical evolution of surgical airway rescue reveals a progress arc from initial resistance to neck operations due to fear of complications, through acceptance of tracheal access for life-saving measures despite high complication rates, to the introduction of synthetic devices that maintain tracheal patency and reduce complications. Various civilizations independently and in parallel made significant observations and advancements in eFONA techniques. The evolution of eFONA underscores a balance between technological advancement and the need for a standardized lexicon and skillset that is regularly maintained by training protocols. Emphasizing the importance of eFONA training- akin to cardiopulmonary resuscitation (CPR) certification maintenance-can enhance readiness and proficiency among health care professionals.