Are you still using cricoid pressure? STOP IT!

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For years we have been using cricoid pressure in the emergency airway, so as to minimise regurgitation when the neuromuscular blocker is given and the gastro-oesophageal sphincter relaxes. The theory is that we use the trachea to compress the posterior lying oesophagus.We need to stop. The only real indication for cricoid pressure is when there is bag valve masking of a patient for a prolonged period.

In a study in Anesthesiology 2003;99:60-64, it was found that:

When cricoid was applied, IN 90.5% of cases the oesophagus was displaced, n 66.7% of cases, cricoid resulted in lateral laryngeal compression and in 81% of cases cricoid resulted in AIRWAY COMPRESSION. So beware!

One of the reasons that compression occurs is that the person doing the compression, doesn’t know how much pressure to apply.

So intubate without cricoid, but still using all those great techniques you all have.

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator

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