Cricoid Force: Anatomic, Physiologic, and Clinical Concepts

The application of cricoid force remains controversial in modern practice. This review critically assesses the anatomic, physiologic, and contemporary clinical evidence of cricoid force application. There may be a sound anatomic basis to cricoid force application, involving occlusion of the postcricoid hypopharynx, but the physiologic basis is uncertain. Clinical evidence to date has not reliably determined efficacy of cricoid force application, largely because of inconsistent localization and application. Modern evidence suggests no clinically relevant implications to successful intubation with cricoid force application, particularly when videolaryngoscopy is used. Paralaryngeal force application demonstrates promise, but the evidence remains insufficient to globally change practice. Overall, the authors found uncertainty regarding the contemporary role of the application of cricoid force; however, when performed, it may be improved by localization of the cricoid cartilage using ultrasound, application of correct force by a trained assistant, and the use of videolaryngoscopy, although strong specific evidence is limited.