35 36 BACKGROUND The "Can't Intubate Can't Oxygenate" (CICO) emergency requires urgent front of neck 37 airway access to prevent death. In cases reported to the 4 th National Audit Project, the most 38 successful front of neck airway (FONA) was a surgical technique, almost all of which were performed 39 by surgeons. Subsequently, UK guidelines adopted surgical cricothyroidotomy as the preferred 40 emergency surgical FONA technique. Despite regular skills-based training, anaesthetists may still be 41 unwilling to perform an emergency surgical FONA. 42 AIM To compare consultant anaesthetists, head and neck surgeons and general surgeons in a high-43 fidelity simulated emergency. We hypothesised that head and neck surgeons would successfully 44 execute emergency surgical FONA faster than anaesthetists and general surgeons. 45 METHODS We recruited 15 consultants from each specialty (total 45). All agreed to participate in an 46 in-situ hi-fidelity simulation of an 'anaesthetic emergency'. Participants were not told in advance 47 that this would be a CICO scenario. 48 RESULTS There was no significant difference in total time to successful ventilation between the three 49 groups (median 86 vs. 98 vs. 126.5 seconds, p=0.078). However, anaesthetists completed the 50 emergency surgical FONA procedure significantly faster than general surgeons (median 50 vs. 86 51 seconds, p=0.018). Despite this strong performance, qualitative data suggested some anaesthetists 52 still believed 'surgeons' best placed to perform emergency surgical FONA in a genuine CICO 53 situation. 54 55 CONCLUSION Anaesthetists regularly trained in emergency emergency surgical FONA function at 56 levels comparable to head and neck surgeons and should feel empowered to lead this procedure in 57 the event of a CICO emergency.