Dr. Weingart is an ED intensivist. This column is a distillation of the best material from the EMCrit Blog and Podcast (http://emcrit.org).
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ACEP Now: Vol 33 – No 07 – July 2014
Dr. Hinds is an intensivist and an Irish Road Racing Doctor. Follow him on twitter @DocJohnHinds..
References
- Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165-75 e1.
- Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet. 1961;2:404-6.
- Koziol CA, Cuddeford JD, Moos DD. Assessing the force generated with application of cricoid pressure. AORN J. 2000;72:1018-1028, 1030.
- Smith KJ, Dobranowski J, Yip G, et al. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiol. 2003;99:60-4.
- Hartsilver EL, Vanner RG. Airway obstruction with cricoid pressure. Anaesth. 2000;55:208-11.
- Allman KG. The effect of cricoid pressure application on airway patency. J Clin Anesth. 1995;7:197-9.
- Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med. 2006;47:548-55.
- Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesth. 2004;59:435-9.
- Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth. 1996;43:414-7.
- Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick’s manoeuvre. Br J Anaesth. 1996;76:877-8.
- Ralph SJ, Wareham CA. Rupture of the oesophagus during cricoid pressure. Anaesth. 1991;46:40-1.
- Hwang J, Park S, Huh J, et al. Optimal external laryngeal manipulation: modified bimanual laryngoscopy. Am J Emerg Med. 2013;31:32-6.
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4 Responses to “Should Cricoid Pressure Be Used During Rapid Sequence Intubation?”
July 21, 2014
EMCrit speaks on cricoid pressure | PHARM[…] Check it out HERE […]
July 21, 2014
roadkillchefExactly – if you make the decision NOT to use cricoid force (having read the evidence, as well as being swayed/amused by Doc Hind’s talk), then make sure that are supported by an institutional guideline/SOP….
…because in the event of an airway catastrophe, it seems inevitable that a prosecution attorney will call upon a crusty old anaesthetist to insist that cricoid force (not pressure) remains a ‘standard of care’.
Better to have institutional standards, appropriate to the circumstances – bot least recognising that in critical care airway management, ensuring first pass success without desaturation (and omitting cricoid force) takes priority over attempts to reduce aspiration risk via cricoid.
It’s a no brainer really – bit like advice to use a checklist for ED RSI!
July 21, 2014
EMCrit Wee - Cricolol by Dr. John Hinds[…] Here is the conference write-up version in ACEP Now […]
February 4, 2019
Lance CarterI’m not sure that I understand the reasoning. I believe that your reasoning behind not using cricoid pressure is that it may interfere with effective ventilation, correct?
I don’t understand this, because during an RSI, the patient wont’ be ventilating. They will be asleep and apneic from the induction agent and paralytic, and you won’t be ventilating for them either, because if you do ventilate for them, it is no longer defined as an RSI.
Therefore, if you’re not going to be ventilating for the patient anyway, why care if cricoid pressure may impede effective ventilation? And why not protect the patient from aspiration? What harm is it going to do an an apneic, non-ventilated patient?