Front of neck airway with Tritube (FONAT): Can it replace tracheostomy?

All challenging airway algorithms end with the situation of Cannot Intubate Cannot Oxygenate (CICO), which requires front of neck access (FONA) to secure a patent airway for the patient. The scalpel-bougie-tube is the standard technique recommended by difficult airway societies, which involves cutting the anterior neck with a surgical blade and making way for a 6-mm tube mounted over a bougie. This can be particularly challenging for anesthesiologists who have little experience with knives or this procedure in general. This is the primary reason FONA is executed late, even though the team is aware that it should be done. In this case report, we describe two cases (emergency and elective) in which we used the needle-catheter-wire technique with some modifications using Tritube to secure the airway and provide mechanical ventilation.