Cricoid pressure: assessment of performance and effect of training in emergency department staff

(i) To evaluate the theoretical knowledge and practical skills of ED staff regarding the technique of cricoid pressure; (ii) to assess the efficacy of two methods of cricoid pressure training.

Theoretical knowledge of participants was assessed by a pretraining questionnaire, and practical ability was assessed using a Flinders Meditech cricoid pressure trainer. Participants then received a brief period of theoretical instruction, and were allocated to two training groups. Group A received further training with the pressure trainer. Group B was provided with reading material. Practical ability was assessed again immediately and then 4-6 weeks later.

Seventy subjects were recruited. A total of 53% could identify the position of the cricoid cartilage, and 16% could identify the pressure required. The percentage achieving a correct position at baseline, immediately after training and after 4-6 weeks was 47%, 97% and 70% respectively in group A, compared with 61%, 86% and 74% respectively in group B, a non-significant difference between groups. The percentage achieving correct pressure at baseline, immediately after training and 4-6 weeks later was 38%, 88% and 67% respectively in group A, compared with 30%, 33% and 51% respectively in group B. The between-group difference was significant only immediately following training (P < 0.0001).

Theoretical knowledge and technique regarding cricoid pressure was poor among our ED staff. Both methods of training appeared to improve performance. The biofeedback group was more likely to apply correct pressure immediately after training. The effects of training diminished rapidly with time.