Cricoid pressure during intubation: A systematic review and meta-analysis of randomised controlled trials

White, Leigh; Thang, Christopher; Hodsdon, Anthony; Melhuish, Thomas; Vlok, Ruan

doi:10.1016/j.hrtlng.2019.10.001

Cited by 14 publications

(13 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 205 Nevertheless, especially if poorly applied, CP can also make tracheal intubation more challenging, 206 and it can also complicate SGA insertion. Evidence on the effectiveness of CP has been conflicting 207 and controversial, creating equipoise around its use. Birenbaum et al recently published a large randomized non-inferiority trial ( n = 3,472 at-risk patients) on the use of CP.…”

Section: Special Situationsmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

View full text Add to dashboard Cite

Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

show abstract

Section: Special Situationsmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

View full text Add to dashboard Cite

show abstract

“…A recent meta-analysis reported that cricoid pressure failed to show any increase in protection from aspiration and may increase difficulty of intubation. 20 …”

Section: Discussionmentioning

confidence: 99%

Manual bag valve mask ventilation performance among respiratory therapists

Culbreth

Gardenhire

2021

Heart & Lung

View full text Add to dashboard Cite

show abstract

“…More recent randomised controlled trials and systematic reviews investigating CP in elective anaesthesia have demonstrated that CP does not significantly reduce the risk of gastric regurgitation and aspiration. 14,15 The true effect of CP on regurgitation is difficult to extrapolate from the available data and remains to be determined for populations undergoing RSI in the ED.…”

Section: Key Findingsmentioning

confidence: 99%

“…CP has been shown to worsen Cormack and Lehane's views during intubation in the operating theatre, likely because of the downward force of CP opposing the upward force of the laryngoscope and distorting the normal anatomy of the airway. 15,16 Poor laryngoscopic view has been associated with prolonged time to intubation and reduced FPS, which increases the risk of complications such as hypoxia, oesophageal intubation, regurgitation, aspiration, airway trauma and cardiac arrest. 14,16,17 However, it is likely that the effects of difficult intubation as a result of CP are overstated, as CP has equally been shown to not affect FPS, and in practice, it is recommended that CP is removed in the case of difficult intubation.…”

Section: Key Findingsmentioning

confidence: 99%

“…14,16,17 However, it is likely that the effects of difficult intubation as a result of CP are overstated, as CP has equally been shown to not affect FPS, and in practice, it is recommended that CP is removed in the case of difficult intubation. 15,16 Despite the controversy surrounding the use of CP during RSI, the current literature has not been able to provide definitive insights into intubation outcomes using this manoeuvre. A 2015 Cochrane review 18 did not identify any completed randomised controlled trials addressing the use of CP during RSI, and two systematic reviews investigating CP during elective surgeries yielded conflicting results; White et al 15 found that FPS was significantly reduced, whereas Hung et al 14 found no significant difference in FPS when CP was applied.…”

Section: Key Findingsmentioning

confidence: 99%

See 1 more Smart Citation

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

Tessarolo

Alkhouri

Lelos

et al. 2022

Emerg Medicine Australasia

View full text Add to dashboard Cite

The use of cricoid pressure (CP) to prevent aspiration during rapid sequence induction (RSI) has become controversial, although CP is considered central to the practice of RSI. There is insufficient research to support its efficacy in reducing aspiration, and emerging concerns it reduces the first‐pass success (FPS) of intubation. This systematic review aims to assess the safety and efficacy of CP during RSI in EDs by investigating its effect on FPS and the incidence of complications, including gastric regurgitation and aspiration. A systematic review of four databases was performed for all primary research investigating CP during RSI in EDs. The primary outcome was FPS; secondary outcomes included complications such as gastric regurgitation, aspiration, hypoxia, hypotension and oesophageal intubation. After screening 4208 citations, three studies were included: one randomised controlled trial (n = 54) investigating the incidence of aspiration during the application of CP and two registry studies (n = 3710) comparing the rate of FPS of RSI with and without CP. The results of these individual studies are not sufficient to draw concrete conclusions but do suggest that aspiration occurs regardless of the application of CP, and that FPS is not reduced by the application of CP. There is insufficient evidence to conclude whether applying CP during RSI in EDs affects the rate of FPS or the incidence of complications such as aspiration. Further research in the ED, including introducing CP usage into other existing airway registries, is needed.

show abstract

Cricoid pressure during intubation: A systematic review and meta-analysis of randomised controlled trials

Cited by 14 publications

References 33 publications

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Manual bag valve mask ventilation performance among respiratory therapists

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

Contact Info

Product

Resources

About