Cricoid pressure - already in decline?

Abstract

Editor—We read with interest the recently published Difficult Airway Society 2015 Guidelines for the management of the unanticipated difficult intubation in adults,1Frerk C Mitchell VS McNarry AF et al.Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.Br J Anaesth. 2015; 115: 827-848Abstract Full Text Full Text PDF PubMed Scopus (1139) Google Scholar and the above debate surrounding the continued inclusion of cricoid pressure (CP) as part of a rapid sequence induction (RSI). We have recently undertaken a survey of CP use during RSI in trauma patients throughout Europe.2Gwinnutt M Gwinnutt J Robinson D The use of cricoid pressure during rapid sequence induction in trauma patients - UK and European practice compared.Trauma. 2016; 18: 21-27Crossref Scopus (5) Google Scholar An anonymised questionnaire was distributed electronically to European Trauma Course (ETC) instructors and received 411 responses. There were marked variations in the reported use of CP amongst both different countries and medical specialties. CP use was reported twice as commonly in the UK (83.1%) compared with all other countries (39.4%), with the lowest use in Denmark (12.5%). Amongst the different specialties, anaesthetists were least likely to use CP (35.6% vs 63.6%). In non-trauma patients where CP has traditionally been advocated (e.g. bowel obstruction, Caesarean section), approximately two-thirds of all respondents indicated that they would not routinely use CP. The two most common reasons cited for not using CP were a perceived lack of evidence of its effectiveness (76.7%) and making intubation more difficult (63.0%). We believe that this study indicates a growing skepticism about the usefulness and subsequent decline in the use of CP, particularly outside of the UK. It also supports the need for more work to clarify the effectiveness of cricoid pressure, in order that those needing to perform RSI can follow an evidence-based approach. None declared.