Cricoid pressure, sometimes called the Sellick maneuver, aims to reduce the risk of regurgitation, usually during intubation prior to anesthesia. It is similar to the BURP (backwards upwards rightwards pressure) technique, but serves a completely different purpose. Though Sellick can lower aspiration risk by preventing regurgitation, BURP improves the ability to see the glottis during intubation. The introduction of cricoid pressure reduced the need for waking intubation, induced hyperventilation, and similar high-stress, high-risk procedures. However, subsequent research suggests that the maneuver may not work as well as originally thought, and can even increase the risk of certain complications, including airway injuries and reduced airway visibility.
First responders and clinicians using this maneuver should proceed with caution. Cricoid pressure demands precision, and so ongoing training is key to getting it right.
Sellick Maneuver Dos
The following strategies can increase the effectiveness of the Sellick maneuver:
- Use the right amount of force. Research shows that about half of practitioners fail to reach the recommended force of 44 N. However, this degree of force may be unnecessary. A force of 30 N in an unconscious patient or 10 N in a conscious patient should be sufficient.
- Ensure that you can see the airway. Excessive cricoid pressure may make it more difficult to visualize the airway, increasing the risk of ventilation difficulties.
- Weigh the risks and benefits. Research on cricoid pressure is contradictory. Some studies show that it occludes the airway or causes other issues, while others do not. Rather than routinely applying cricoid pressure, weigh the risks and benefits associated with its use in each individual patient. When cricoid pressure is risky or difficult, consider alternative strategies such as the head-up tilt.
- Be mindful of ongoing research on the Sellick maneuver. This technique is a controversial one, and research is ongoing. Understanding how this research applies to your patient population can make you a wiser, safer practitioner.
- Undergo regular training. The high-stress scenarios most practitioners encounter are miles apart from the classroom setting. Nevertheless, classroom training can help prepare you to apply cricoid pressure in crisis situations. Don’t assume that you’ll get it right next time just because you got it right before. Cricoid pressure is a precision technique that demands precision training.
Sellick Maneuver Don’ts
The following tips can help you safely administer cricoid pressure:
- Do not use the Sellick maneuver when safer techniques are available, or when there is no indication that its use is necessary.
- Do not use excessive pressure. This can displace the esophagus and increase the risk of airway difficulties.
- Don’t assume that cricoid pressure removes the risk of regurgitation or aspiration. When improperly applied, it may increase these risks.
- Don’t prematurely release the pressure. When applied only briefly, cricoid pressure becomes more dangerous, and may elevate the risk of complications.
- Don’t forget your equipment. Patients may still regurgitate or even aspirate. The Sellick maneuver is not a substitute for proper medical treatment, nor for having the right equipment available. Ensure that you have a suctioning machine ready to go in the event of aspiration. If the patient is actively bleeding or continuously vomiting—a potential side effect of this maneuver—be prepared to initiate suction-assisted laryngoscopy and airway decontamination (SALAD).
How Suctioning Helps
The Sellick maneuver is increasingly controversial, especially as better equipment that can prevent aspiration becomes available. The right suction machine can maintain a patient’s airway and quickly intervene if a patient begins to regurgitate. Portable suction enables you to tend to patients wherever they are, without moving them. For help selecting the ideal portable suction device for your organization or agency, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.
