Trainability of Cricoid Pressure Force Application: A Simulation-Based Study

Anesthesia and Analgesia
Eric NollElliott Bennett-Guerrero

Abstract

Aspiration of gastric contents is a leading cause of airway management-related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10-30 N during application of CP. Clinicians (attending anesthesiologist, anesthesiology residents, certified registered nurse anesthetists, or operating room nurses) applied CP on a Vernier force plate simulator with measurements taken at 4 time points over 60 seconds, 2 measurements before and 2 measurements after loss of consciousness. A successful cycle required all 4 time points to be within the target range (10 ± 5 and 30 ± 5 N, respectively). After baseline assessment (n = 100 clinicians), a subset of 40 participants volunteered for education on recommended force targets, underwent self-regulated practice, and then performed 30 1-minute cycles of high-frequency simulation analyzed by cumulative sum analysis to assess thei...Continue Reading

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Citations

Sep 14, 2018·Anesthesia and Analgesia·M Ramez SalemAhed Zeidan
Feb 28, 2019·JAMA Surgery·Eric NollElliott Bennett-Guerrero
Aug 10, 2019·Anesthesia and Analgesia·Marko ZdravkovicSorin J Brull
Jan 25, 2020·Anesthesia and Analgesia·Hans-Joachim Priebe

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