Key result
Routine cricoid pressure during rapid-sequence intubation lacks trial evidence for preventing aspiration.
Why the study?
The application of cricoid pressure during rapid-sequence intubation is controversial due to concerns about its effectiveness and potential to worsen airway management.
Supports prompt cricoid release during difficult intubation; leaves open the need for RCTs on aspiration prevention.
Airway management is the most important clinical skill for anesthesiologist, emergency physician, and other providers who are involved in oxygenation and ventilation of the lungs. Rapid-sequence intubation is the preferred method to secure airway in patients who are at risk for aspiration because it results in rapid unconsciousness (induction) and neuromuscular blockade (paralysis). Application of cricoid pressure (CP) for patients undergoing rapid-sequence intubation is controversial. Multiple specialty societies have recommended that CP is not effective in preventing aspiration; rather it may worsen laryngoscopic view and impair bag-valve mask ventilation. Some experts think that CP should be applied in trauma and patients at risk for aspiration; however CP, if necessary, should be altered or removed to facilitate intubation.
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Ramaiah et al. (2014) conducted a review in Airway management. Cricoid pressure during rapid-sequence intubation was evaluated. The routine application of cricoid pressure during rapid-sequence intubation remains controversial due to a lack of randomized controlled trials demonstrating its efficacy in preventing aspiration.
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