Why was cricoid pressure stopped?

[Handsome Robb]

I just want to highlight a point about cricoid pressure (i.e Sellick's) that is misunderstood by many people, including some physicians. It boils down to this:

Cricoid pressure ≠ BURP ≠ External laryngeal manipulation

I go in a bit more detail in my review Intubation and Mis-en-place, but let me summarize the key distinctions:


Cricoid is not used to improve the view of the cords - it's been shown to worsen the view, actually. (See the review for citations)

With that in mind, release of cricoid pressure is the first thing I ask for when the view of the cords isn't great.

Proper positioning and bimanual external laryngeal manipulation (ELM) is far superior to BURP. Ever since I switched to face-neutral/ear-to-sternal notch positioning I've not once required BURP (n=8ish) and used ELM only twice.

Much appreciated, thank you!

 

[AnthonyM83]

ROUTINE use of cricoid pressure when ventilating with a BVM is no longer recommended. One can STILL use it when needed or as part of RSI procedure prior to intubation or to help visualize the cords during intubation.

KellyBracket's distinctions are also important.