A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice

Abstract

We conducted a survey of Australian and New Zealand anaesthetists designed to quantify self-reported use of cricoid pressure (CP) in patients presumed to be at risk of gastric regurgitation, and to ascertain the underlying justifications used to support individual practice. We aimed to identify the perceived benefits and harms associated with the use of CP and to explore the potential impact of medicolegal concerns on clinical decision-making. We also sought to ascertain the views of Australian and New Zealand anaesthetists on whether recommendations relating to CP should be included in airway management guidelines. We designed an electronic survey comprised of 15 questions that was emailed to 981 randomly selected Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) by the ANZCA Clinical Trials Network on behalf of the investigators. We received responses from 348 invitees (response rate 35.5%). Of the 348 respondents, 267 (76.9%) indicated that they would routinely use CP for patients determined to be at increased risk of gastric regurgitation. When asked whether participants believed the use of CP reduces the risk of gastric regurgitation, 39.8% indicated yes, 23.8% believed no and 36.3% were unsure. Of the respondents who indicated that they routinely performed CP, 159/267 (60%) indicated that concerns over the potential medicolegal consequences of omitting CP in a patient who subsequently aspirates was one of the main reasons for using CP. The majority (224/337; 66%) of respondents believed that recommendations about the use of CP in airway management guidelines should include individual practitioner judgement, while only 55/337 (16%) respondents believed that routine CP should be advocated in contemporary emergency airway management guidelines.

Review article: Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation in the emergency department: A systematic review

“…3 The incidence of regurgitation and aspiration has been found to be between 3 and 13% of ED intubations, and the risk increases with repeated intubation attempts and prolonged time to intubation. [4][5][6] Successful intubation on the first attempt, known as firstpass success (FPS), is thus an important goal of RSI. 2,4 Cricoid pressure (CP) is a manoeuvre used during RSI to further reduce the risk of gastric regurgitation and aspiration.…”

Comment on ‘A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice’

“…We read with great interest the article, entitled ‘A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: attitude and practice’. 1 We compliment the authors for expending the time and effort to complete such an elucidative project. Since cricoid pressure (CP) was added to rapid sequence intubation (RSI) in 1961, surveys have been performed to assess its use and acceptance among clinicians.…”

“…The responses were mixed: 76.9% of responders indicated that they would routinely use CP in adults and children at increased risk of gastric regurgitation; 39.8% believed that the use of CP reduced the risk of gastric regurgitation; 36.3% were unsure; and 23.8% believed it did not. 1 This lukewarm enthusiasm by responders to the survey suggests that their experience with CP was far from satisfactory. We believe that this can be explained primarily by a lack of proper training and an inattention to details by some of the CP users, rather than being a reflection of the inherent shortcomings of the technique itself.…”

Reply to comment on ‘A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists; Attitudes and practice’

“…Reply to comment on 'A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists; Attitudes and practice' Ravi Mistry 1 and Daniel R Frei 2,3 We thank Khorasani and colleagues for their interest in our recent publication 1 and their thoughtful criticisms.…”