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

• Published in: Heart & lung Vol. 49; no. 2; pp. 175 - 180
• Main Authors: White, Leigh, Thang, Christopher, Hodsdon, Anthony, Melhuish, Thomas, Vlok, Ruan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: Airway mangement; Cricoid pressure; Cricoid pressure; Airway mangement
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2019.10.001

•This was a systematic review of RCTs comparing cricoid pressure to a no cricoid or sham cricoid during intubation•Twelve high quality RCTs with 4862 adult non-obstetric patients met the inclusion criteria•There was no difference in aspiration (RR = 1.18;95%CI = 0.71 to 1.96;I2 = 0%;p = 0.51)•Cricoid pressure was associated with worse first attempt success, time to intubation and laryngoscopy views.•The patient population included were a relatively low risk, non-obstetric, adult cohort of patients. This systematic review and meta-analysis aimed to determine whether cricoid pressure protects against aspiration and whether this technique adversely affects intubating conditions in adult patients. A systematic review of five databases was performed for randomised controlled trials comparing cricoid pressure to no cricoid or sham cricoid during intubation. The primary outcome was incidence of aspiration and the secondary outcomes included first attempt intubation success, time to intubation, Cormack and Lehane Grade 3 or 4 and difficult intubation. The search identified twelve high quality RCTs with 4,862 patients for inclusion. Among four studies reporting the primary outcome, there was no difference (RR=1.18; 95%CI=0.71 to 1.96; I2=0%; p=0.51). Only 3 studies were in patients at high risk of aspiration. There was significantly worse first attempt success (RR= 0.94; 95%CI= 0.89 to 0.99; I2=66%; p=0.02), time to intubation (WMD= 6.77seconds; 95%CI=4.40 to 9.14seconds; I2=97%) and laryngoscopy views (RR=1.69; 95%CI=1.41 to 2.02;I2=1%; p<0.00001) with cricoid pressure. Cricoid pressure failed to show any increase in protection from aspiration and may increase difficulty of intubation. Further studies in high-risk patients, such as intensive care patients, are required.