The Role of Cricoid Pressure in Rapid Sequence Induction

Abstract

Abstract Purpose of the Review This review summarizes current knowledge regarding cricoid pressure in rapid sequence induction. It assesses anatomical concepts, current practice, guidance, evidence of safety and efficacy, and future directions. Recent Findings Guidelines have variable recommendations for cricoid pressure, and surveys underscore this variation in practice. Systematic reviews and meta-analyses suggest that cricoid pressure may be associated with worse views at direct laryngoscopy, but there is currently no robust data demonstrating that cricoid pressure reduces the risk of pulmonary aspiration. However, evidence demonstrates that correct anatomical localization of the cricoid cartilage is inaccurate without the use of ultrasound, and therefore most of the existing evidence is currently unreliable regarding true efficacy. Moreover, the widespread use of videolaryngoscopy means that worsening views at laryngoscopy might be less of a concern than previously thought. Summary Current literature and global practice suggest that it is a clinician’s decision based on individual patient risks, and that cricoid pressure—as it is currently performed—likely provides no benefit but probably does minimal clinically relevant harm. The role of accurate cricoid cartilage localization and videolaryngoscopy remains to be fully investigated.