Cricoid pressure: an alternative view

Abstract

Although the use of cricoid pressure (CP) seems to make intuitive sense, its scientific basis is weak at best and lacking at worst. It is based on studies of saline regurgitation in cadavers and a study of a small number of patients. More than 40 years after Sellick’s description of CP, still no randomized controlled trial has been conducted to assess, let alone prove, the effectiveness of CP in preventing pulmonary aspiration of gastric content. Relying solely on CP as a preventive measure has numerous pitfalls. We possibly endanger more patients by interfering with optimal airway management than we save lives through prevention of aspiration of gastric content. It is potentially dangerous to consider CP to be effective in most cases and to become complacent about the many factors that contribute to regurgitation and aspiration. By today’s standards, CP can hardly be considered an evidence-based practice.