Rapid sequence induction-intubation and cricoid pressure – facts and fallacies

Abstract

Rapid sequence induction-intubation (RSII) is ‘the standard of care’ practice since decades while anaesthetising a full stomach patient or during emergency airway management. Cricoid pressure (CP), an important manoeuvre, labelled as the ‘linchpin of rapid sequence induction-intubation’, when not performed properly can lead to catastrophic results. The purpose of this review of literature is to discuss if rapid sequence induction and application of cricoid pressure is a safe and effective technique in managing a full stomach patient. Literature from multiple sources was searched for key words, subject headings and text entries on rapid sequence induction, rapid sequence induction and intubation, and cricoid pressure. Outcomes such as prevention of aspiration and prevention of other airway complications such as airway trauma could not be evaluated based on the literature available at present. There is lack of clear cut evidence from randomised controlled trials on the safety and effectiveness of rapid sequence induction-intubation and cricoid pressure. Despite wide acceptance of RSII, its role in emergency airway management is still debated. CP as an essential skill, lacks in its uniformity among clinicians, technicians and nurses, and simulation based training hold promise in this regard.