{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T16:44:14Z","timestamp":1785689054640,"version":"3.56.0"},"reference-count":9,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,11,3]],"date-time":"2017-11-03T00:00:00Z","timestamp":1509667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001771","name":"University of Newcastle Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2018,1]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>This study was a prospective, randomized controlled trial of rapid sequence intubation (RSI<\/jats:styled-content>) with cricoid pressure (CP<\/jats:styled-content>) within the emergency department (ED<\/jats:styled-content>). The primary aim of the study was to examine the link between ideal CP<\/jats:styled-content> and the incidence of aspiration.<\/jats:p><\/jats:sec>Method<\/jats:title>Patients\u00a0>\u00a018 years of age undergoing RSI<\/jats:styled-content> in the ED<\/jats:styled-content> of two hospitals in New South Wales, Australia, were randomly assigned to receive measured CP<\/jats:styled-content> using weighing scales to target the ideal CP<\/jats:styled-content> range (3.060\u20134.075\u00a0kg) or control CP<\/jats:styled-content> where the weighing scales were used, but the CP<\/jats:styled-content> operator was blinded to the amount of CP<\/jats:styled-content> applied during the RSI<\/jats:styled-content>. A data logger recorded all CP<\/jats:styled-content> delivered during each RSI<\/jats:styled-content>. Immediately after intubation, tracheal and esophageal samples were taken and underwent pepsin analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>Fifty\u2010four RSI<\/jats:styled-content>s were analyzed (25 measured\/29 control). Macroscopic contamination of the larynx at RSI<\/jats:styled-content> was observed in 14 patients (26%). During induction (0\u201350 seconds), both groups delivered in\u2010range CP<\/jats:styled-content>. During intubation (51\u2013223 seconds), laryngoscopy was associated with a reduction in mean CP<\/jats:styled-content> below 3.060 kg in both groups. When compared, there was no statistically significant difference between the groups. For 11 patients, pepsin was detected in the oropharyngeal sample, while three were positive for tracheal pepsin. Seven patients (four control\/three measured) were treated for clinical aspiration during hospitalization. As a result of the finding that neither group could maintain ideal range CP<\/jats:styled-content> during laryngoscopy, the trial was abandoned.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Laryngoscopy provides a counter force to CP<\/jats:styled-content>, which is negated to facilitate tracheal intubation. The concept that a static 3.060 to 4.075\u00a0kg CP<\/jats:styled-content> could be maintained during laryngoscopy and intubation was rejected by our study. Whether a lower CP<\/jats:styled-content> range could prevent aspiration during RSI<\/jats:styled-content> was not explored by this study.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13326","type":"journal-article","created":{"date-parts":[[2017,9,28]],"date-time":"2017-09-28T16:20:57Z","timestamp":1506615657000},"page":"94-98","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Ideal Cricoid Pressure Is Biomechanically Impossible During Laryngoscopy"],"prefix":"10.1111","volume":"25","author":[{"given":"Christopher E.","family":"Trethewy","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Central Coast Local Health District Gosford NSW Australia"},{"name":"Department of Rural Health Faculty of Health and Medicine Tamworth NSW Australia"},{"name":"University of Newcastle Tamworth NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven R.","family":"Doherty","sequence":"additional","affiliation":[{"name":"School of Rural Medicine University of New England Armidale NSW Australia"},{"name":"Hunter New England Health Local Health District Tamworth Rural Referral Hospital Tamworth NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Burrows","sequence":"additional","affiliation":[{"name":"Department of Rural Health Faculty of Health and Medicine Tamworth NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Clausen","sequence":"additional","affiliation":[{"name":"Pathology North Tamworth Rural Referral Hospital Tamworth NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/31.11.493"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(61)92485-0"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.125683"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-197006000-00019"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/44.4.401"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.1999.00756.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1992.tb03248.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-13-17"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1984.tb08932.x"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.13326","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.13326","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.13326","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.13326","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T19:14:12Z","timestamp":1695755652000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.13326"}},"subtitle":[],"editor":[{"given":"Rob","family":"Reardon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2017,11,3]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,1]]}},"alternative-id":["10.1111\/acem.13326"],"URL":"https:\/\/doi.org\/10.1111\/acem.13326","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,3]]},"assertion":[{"value":"2017-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}