Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia. The IRIS Cricoid Trial

Aurélie Birenbaum. JAMA Surg 2018, published online October 17th 2018 doi:10.1001/jamasurg.2018.3577

Clinical Question

• In patients undergoing rapid sequence anaesthesia induction, does the use of cricoid pressure vs. a sham procedure, prevent pulmonary aspiration?
  N = 3472, 10 centres in France

Authors’ Conclusions

• This study failed to demonstrate non-inferiority of the sham procedure in preventing pulmonary aspiration

The Bottom Line

• In patients undergoing general anaesthesia with RSI, this RCT failed to demonstrate the non-inferiority of a sham procedure compared with cricoid pressure at preventing pulmonary aspiration. However, the negative outcome may be more attributable to the study design
• Should the question have been ‘Is cricoid pressure beneficial, given the known harms?’ using a superiority design
• This study highlights that the benefits of cricoid remain unproven, however it reinforces concerns about harms of cricoid pressure through interference with intubation
• It is unclear if this is applicable to patients in ICU or ED
• Further studies need to be undertaken which include pregnant women