The Clinical Use of Cricoid Pressure: First, Do No Harm

Area of Science:

• Anesthesiology
• Patient Safety
• Critical Care Medicine

Background:

• Cricoid pressure (CP) is a long-standing practice during rapid sequence induction and intubation.
• Its efficacy in preventing pulmonary aspiration remains debated due to limited scientific proof.
• Current international guidelines vary on recommending CP, reflecting the evidence gap.

Purpose of the Study:

• To objectively review the scientific evidence on the effectiveness and safety of CP.
• To critically discuss the limitations of existing data regarding CP's role in aspiration prevention.
• To address the lack of a universally accepted medical-legal standard for high-risk aspiration patients.

Main Methods:

• Comprehensive literature review of studies evaluating CP during rapid sequence induction and intubation.
• Analysis of evidence regarding CP's impact on preventing gastric content aspiration.
• Comparative discussion of US and international practices concerning CP use.

Main Results:

• Existing scientific evidence is inadequate to support mandatory clinical guidelines for CP use.
• There is no guaranteed method to prevent aspiration in all patients.
• Significant limitations exist in current research methodologies.

Conclusions:

• Current data do not justify imposing clinical guidelines on CP application.
• Further high-quality studies are needed to establish the effectiveness and safety of CP.
• Recommendations are proposed for designing future research on CP.