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Cricoid pressure is a widely accepted, yet highly questionable maneuver employed by airway management specialists. The function of cricoid pressure is to help prevent gastric regurgitation and pulmonary aspiration when intubating high-risk patients. Although initially well-received by the medical community, the status of cricoid pressure as a standard of care has been challenged by arguments that this procedure is ineffective, unsafe, and generally unfit for clinical practice. Moreover, the lack of a standardized protocol has contributed to significant discrepancies in the way cricoid pressure is applied. A literature analysis reveals insufficient data to determine whether or not cricoid pressure decreases the risk of regurgitation. However, the maneuver can still be deemed effective because of its anatomical basis. Advanced imaging studies affirm the ability of cricoid pressure to occlude the lumen of the postcricoid hypopharynx, physically impeding passage of gastric or esophageal content through the point of compression. An evaluation of cricoid pressure protocol is done in an effort to establish a standardized set of guidelines. Although a general consensus has been reached regarding certain aspects of the maneuver, such as force and timing, further research is required to thoroughly understand its additional intricacies. In the meantime, a cautious approach to applying cricoid pressure is strongly advised.

Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.