One of the most controversial manoeuvres in anaesthesia and critical care has got some new support since the Difficult Airway Society has published their new guidelines in which they basically continue to support the use of cricoid pressure (CP) for rapid sequence induction. The authors of the Obstetric Anaesthetists' Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation also continue to recommend routine CP, which is considered level 3b evidence.
Surprised on how obstinately CP persists in current guidelines I think that following statement by Priebe HJ is an important reading. It summarises nicely why there is such a disagreement with these recommendations.
He states that
- not a single controlled clinical study provided convincing evidence that the use of cricoid pressure was associated with a reduced risk of pulmon ary aspiration. At the same time, there is good evidence that nearly all aspects of airway management are adversely affected by cricoid pressure
- if cricoid pressure were considered a new airway device, it would not be considered for further evaluation because Level 3B evidence for its efﬁcacy does not exist
- when using cricoid pressure, we may well be endangering more lives by interfer ing with optimal
airway management than we are saving lives by preventing pulmonary aspiration
Priebe HJ, Anaesthesia 2016, 71, 343–351
Want to get more information on the controversy of cricoid pressure? Read here:
Cricoid Pressure for RSI in the ICU: Time to Let GO?
Time to let go? Remarkable article on RSI and Cricoid Pressure
Difficult Airway Society DAS: New Guidelines OUT! Cricoid Pressure still IN?