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Neck Rescue: the emergency procedure for urgently restoring airway patency by creating a passage for oxygen delivery between the anterior neck and trachea in the time-critical situation of insurmountable upper airway obstruction.

Numerous alternative term are in use including: (emergency) front-of-neck airway (eFONA) (DAS guidelines), (emergency) front-of-neck access (eFONA) (DAS guidelines), emergency surgical airway, cricothyroidotomy (or cricothyrotomy or ‘cric’), tracheostomy (or tracheotomy or ‘trach’), invasive airway access (ASA guidelines), direct tracheal access (NAP4), percutaneous emergency oxygenation, percutaneous emergency airway access, infraglottic rescue (ANZCA transition document), CICO rescue (Vortex Approach), emergency subglottic transtracheal access (CAFG guidelines), ‘cut the neck’.

The issues involved in selecting appropriate terminology for this procedure are discussed in detail in this article. In particular terminology that is simple, concise, intuitive (in context to those previously unfamiliar with it), precise (with respect to the time-critical nature of the procedure), flexible (with respect to the exact anatomical site - cricothyroid membrane or trachea - at which it is performed) and unitimidating is desirable. It was not felt that any of the current legacy terms adequately satisified all these criteria, hence the term ‘neck rescue’ was introduced. In particular emergency front-of-neck airway/access (currently the dominant legacy term in the literature) can cause confusion due to the tendency to drop the ‘emergency’ prefix for brevity (something that even the Difficult Airway Society (who developed the term) have done in their own guideline publications), leading to a lack of clarity about the need for suitably rapid techniques to restore airway patency in the time-critical situation of insurmountable upper airway obstruction, that could compromise patient safety. Emergency front-of-neck airway/access also predisposes to contraction to the acronym eFONA which if verbalised in an emergency would be incomprehensible to the uninitiated.

Neck Rescue Emergency: the situation of insurmountable upper airway obstruction in which best efforts at all three core upper airway options have been unsuccessful in achieving airway success and neck rescue must be initiated.

A variety of terms are used in the literature to describe this situation including ‘can’t intubate, can’t ventilate' (CICV - ASA guidelines), ‘can’t intubate, can’t oxygenate’ (CICO - DAS guidelines), ‘can’t ventilate, can’t oxygenate’ (CVCO - Canadian Airway Focus Group guidelines) and ‘complete ventilation failure’ (All India Difficult Airway Association guidelines). As well as a lack of clarity regarding the meaning of the terms ‘oxygenation’ and ‘ventilation’ and an excessive emphasis on intubation in the terms CICO & CICV, this multitude of legacy terms can also erroneously create the impression that they each refer to distinct clinical situations, some of which may not necessarily be perceived as being inextricably linked to the need to perform neck rescue. This could lead to a lack of clarity about the need for performance of neck rescue when they are declared. Rather than use a term that focuses on the problem, whose meaning & implications are potentially subject to confusion, it was felt that a term to which the solution was intrinsic was preferable. Declaring a ‘neck rescue emergency’ clearly and unavoidably communicates to the team that performance of neck rescue is required.