Front-of-Neck Access Cannot Overcome Distal Tracheobronchial Obstruction: A Fatal Case of Mochi Impaction.

Emergency front-of-neck access (FONA) is a last-resort intervention in "cannot intubate, cannot oxygenate" situations. The underlying assumption is that establishing an airway at the cricothyroid membrane will restore ventilation. We report a fatal case in which FONA via percutaneous cricothyroidotomy failed to restore ventilation in a patient with cardiac arrest due to mochi (sticky rice cake) aspiration. A 51-year-old man presented in pulseless electrical activity cardiac arrest after choking on mochi. Bag-mask ventilation was ineffective, and the oropharynx was densely packed with mochi, precluding visualization of the epiglottis. Percutaneous cricothyroidotomy was performed, but ventilation remained ineffective despite technically successful placement. Subsequent endotracheal intubation after oral clearance also failed to achieve ventilation. Postmortem computed tomography revealed a patent airway at the cricothyroid level with obstructing foreign material in the mid-trachea and near-complete occlusion at the carina. This case illustrates that FONA cannot overcome distal tracheobronchial obstruction and highlights a structural limitation of front-of-neck airway access in the management of mochi aspiration.