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

Leigh D. White, Wagga Wagga Rural Referral Hospital, University of Queensland, Sunshine Coast University Hospital
C Thang, University of Queensland
Anthony Hodsdon, University of Wollongong
Thomas M. Melhuish, Royal Prince Alfred Hospital, University of New South Wales, Wagga Wagga Rural Referral Hospital
Ruan Vlok, University of Notre Dame, University of New South Wales, Wagga Wagga Rural Referral Hospital

White, L., Thang, C., Hodsdon, A., Melhuish, T. & Vlok, R. (2020). Cricoid pressure during intubation: A systematic review and meta-analysis of randomised controlled trials. Heart and Lung, 49 (2), 175-180.

Abstract

2019 Elsevier Inc. Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.

 

Link to publisher version (DOI)

http://dx.doi.org/10.1016/j.hrtlng.2019.10.001