As a postscript to my previous post on the use of cricoid pressure during RSI, I have just seen this abstract of a survey conducted in the United States regarding a modified RSII, entitled, Modified Rapid Sequence Induction and Intubation: A Survey of United States Current Practice. I have not seen the complete article yet, but the abstract seems to confirm cricoid pressure as one of three key components of a modified RSII, along with oxygen administration before induction and an attempt to ventilate the patient’s lungs before securing the airway. As the authors comment themselves, ‘Although this definition seems intuitively obvious, no previous work has tested whether it is commonly accepted’.
490 surveys were received from 58 institutions. 93% of respondents reported using a modified RSII. A majority of respondents (71%, CL: 63%-77%) reported administering oxygen before anesthesia induction, applying cricoid pressure, and attempting to ventilate the lungs via a facemask before securing the airway.
Staying with the United States, albeit via a UK report, it was noted in the UK 4th National Audit Project (NAP4) that the American Society of Anesthesiologists (ASA) Closed Claims Practice Group reported that cricoid force was ‘used’ in half of claims relating to aspiration. Claims for aspiration in which cricoid pressure was applied were settled for lower awards than those where it was omitted.
Interestingly, one of the recommendations in NAP4 related to RSI was as follows, ‘On balance, rapid sequence induction should continue to be taught as a standard technique for protection of the airway. Further focused research might usefully be performed to explore its efficacy, limitations and also explore the consequences of its omission.’
No doubt the debate about RSI and cricoid pressure will continue…