Stop Using the Sellick Maneuver for Rapid Sequence Intubation

The Sellick maneuver — applying pressure to the cricoid cartilage during rapid sequence intubation (RSI) — is designed to prevent aspiration when fasting is not possible. Though it had been widely recommended as part of the dogma of airway management and is perhaps intuitive, no large randomized trials have evaluated its efficacy.

This study enrolled 3471 adult (>18 years old) patients who required RSI and general anesthesia for surgery at 10 academic medical centers in France. Participants had <6 hours of fasting or at least one risk factor for aspiration. Participants were randomized to cricoid pressure performed by an anesthesiologist who underwent monthly training to ensure consistent application of 30 N of pressure, or a sham procedure …