A protocol for an emergency front-of-neck airway registry in the United Kingdom

Background: A 'cannot intubate, cannot oxygenate' crisis is a rare but life-threatening airway emergency, with an emergency front-of-neck airway (eFONA) required to establish or maintain oxygenation. Episodes of eFONA are rare, with the UK-wide Fourth National Audit Project from the Royal College of Anaesthetists in 2011 reporting 58 cases of eFONA in 1 yr. This registry project aims to collect and analyse data systematically from a cohort of cases where eFONA has been attempted to improve understanding of these rare events. Methods: After appropriate regulatory approvals, the emergency front-of-neck airway registry (eFONAr) will collect details of voluntarily and anonymously reported, de-identified cases in which an eFONA was attempted from hospitals within the UK. The dataset has been developed and piloted using a modified Delphi approach and incorporates pre-, intra-, and post-event data on planning, processes, equipment, and human and team factors. A panel will generate a systems-based analysis of events and decision-making in the process of eFONA. Outcomes: The registry will provide estimates of population characteristics, procedural details, and eFONA incidence. The systems analysis will support future recommendations for research, clinical practice, and organisational policies related to eFONA. Clinical protocol registration: Open Science Framework (https://osf.io/kbmp4).