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Archived Comments for: Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial

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  1. Baseline incidence of aspiration is way too high

    Philip Jones, LHSC

    14 January 2015

    There are several issues here:
    1) The baseline incidence of aspiration you quote (11%) is far too high. Warner's retrospective review of 172,000 patients (Anesthesiology 78:1, 56-62) showed an incidence of 0.03%. Although these were in mostly fasted patients, even if your incidence were 100-fold higher, the baseline incidence would be only by 3%. To show a change from 3% to 0% with 90% power would require 680 patients. Therefore, your study is very likely to be underpowered.
    2) What is the clinical significance of the pepsin test? It will be perhaps easy to show pepsin presence, but linking this in some meaningful way to clinical aspiration with bad effects will be difficult.

    Competing interests