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Lesson

Cricoid Pressure & Gastric Distention

10 min Airway & Breathing Skip to quiz

Objective: Do not use cricoid pressure as a habit. Bag slowly enough that the chest rises and the belly does not. A swelling stomach is a ventilation problem you can fix.

Why this matters

Some people were taught to put cricoid pressure on every tube. Cricoid pressure is a thumb-and-finger squeeze on the cricoid ring. The old idea was to pinch the esophagus shut.

Routine cricoid pressure can make the view worse. It is not a proven way to stop aspiration. Do not use it as your default.

The common harm is air in the stomach from fast, hard bagging, especially with a leaky mask. The belly rises. The diaphragm is pushed up. Then you cannot ventilate.

Key points
  • Use a two-person bag-valve-mask (BVM). Squeeze slowly, for about one second. Watch the chest. If the upper belly swells, air is going into the stomach.
  • Do not apply cricoid pressure out of habit. If your protocol still uses it for one rapid sequence intubation step, follow that step. It is not part of basic life support bagging.
  • Decompress the stomach with an orogastric or nasogastric tube if you have one and the belly is the problem. Backward-upward-rightward pressure (BURP) on the thyroid cartilage is not the same as cricoid pressure.

Clinical sequence

  1. Open the airway, suction, use a two-person seal, and place an airway adjunct. Squeeze over about one second. Watch the chest rise. Do not watch fingers on the cricoid.
  2. If the belly rises, slow the rate, use a smaller volume, and fix the seal. Consider a supraglottic airway you can still bag through.
  3. If the stomach is already tight and the patient is getting worse, decompress it per protocol while you fix the airway.
  4. Intubation looks still follow attempt limits. Cricoid pressure is not the reason a tube missed.

Teaching points

  • Routine cricoid pressure can move the airway. The evidence that it prevents aspiration is weak. Do not use it as the default during BVM ventilation.
  • Air in the stomach comes from a fast rate, a large volume, and a poor seal. That is a bagging problem. It is not a reason to add cricoid pressure.
  • Cricoid pressure is also called Sellick pressure. BURP pushes the thyroid cartilage backward, upward, and to the patient’s right. It can improve a view. That is not Sellick pressure, and it is not pressure on the cricoid ring. Say which one you are doing.
  • A tight, drum-like belly after bagging needs a tube in the stomach if you are trained and equipped. You also need a better ventilation plan.
Verbalize
  • I am not using routine cricoid pressure.
  • I am bagging slowly. I am watching the chest, not the belly.
  • The belly is rising. I am fixing the seal, slowing the bag, and decompressing the stomach if I am trained to do it.
  • BURP on the thyroid cartilage is not cricoid pressure. I am naming which one I want.

Common errors

  • Using cricoid pressure on every BVM because that is how you were taught.
  • Squeezing the bag as fast as chest compressions in a patient who still has a pulse.
  • Ignoring a swelling upper belly while you keep taking laryngoscopy looks.

Practice

One-minute check

Your partner bags at 20 breaths per minute. The belly is rising and the oxygen saturation is falling. Name two corrections. Then a helper puts two-handed cricoid pressure on a patient with a pulse. What do you say?

Related: Effective BVM Ventilation, Airway Attempt Limits.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Routine cricoid pressure during BVM is:
2. A rising epigastrium (upper belly) while bagging means:
3. BURP (backward-upward-rightward pressure on the thyroid cartilage) is:
4. The BVM rate problem that fills the stomach is:
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