Cricoid has been selectively vilified out of RSI in some settings but has more evidence, less risks and a better rationale than any other cited component. So why not do it routinely for all tracheal intubations? Let the games begin. In @Anaes_Journal …-publications.onlinelibrary.wiley.com/doi/10.1111/an…

@NicholasChrimes @Anaes_Journal There are MRI studies that show it does not reliably achieve what we think it does, I prefer my ODP with two free hands.

@ICMdoc @NicholasChrimes @Anaes_Journal It occludes the hypopharynx People mistakenly focus on the oesophagus and the oesophagus don’t even start til below the cricoid so of course is not occluded The papers are useful journals.lww.com/anesthesia-ana… journals.lww.com/anesthesia-ana… Recent review journals.lww.com/anesthesiology…

@doctimcook @NicholasChrimes @Anaes_Journal Interesting, will have a read. Is there any decent evidence it actually reduces aspiration events?

The evidence is uncertain There is logic to its use inasmuch as -aspiration is a significant complication and efforts to prevent it merit careful examination -cricoid occludes the upper GI tract (hypopharynx) -the metrics for correct cricoid are well defined 3 kg one hand unable to sustain > 5 mins -it’s easy to teach (closed 50 ml syringe, compress air from 50-32 ml) achieves good accuracy +/-0.5 kg which keeps in effective and safe range -when applied correctly it has either nil or minimal impact on airway management -if its causing a problem, take it off and you’ve lot nothing The biggest challenge is -teaching it correctly -correctly identifying cricoid ( we should use more USS) -misinformation and a view that absence of evidence equals evidence of absence of benefit Embrace and accept uncertainty So I use RSI in high risk cases