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

Area of Science:

• Anesthesiology
• Patient Safety
• Airway Management

Background:

• Aspiration of gastric contents is a major cause of mortality during anesthesia.
• Cricoid pressure (CP) is recommended during rapid sequence induction to prevent aspiration.
• National guidelines suggest specific force targets for CP (10 N before, 30 N after loss of consciousness).

Purpose of the Study:

• To evaluate if clinicians can be trained to consistently apply the recommended cricoid pressure (CP) force.
• To assess the effectiveness of simulation-based training in achieving target CP forces.

Main Methods:

• 100 clinicians applied CP on a force plate simulator.
• A subset of 40 clinicians received education and practiced simulation.
• Performance was measured by successful cycles within target force ranges (10 ± 5 N and 30 ± 5 N).

Main Results:

• Baseline success rate was very low (1.3%).
• After training, success rates improved to 16%, reaching 45% in later practice cycles.
• No participant achieved proficiency, as defined by consistently meeting target forces.

Conclusions:

• Clinicians demonstrate poor performance in applying guideline-recommended cricoid pressure forces at baseline.
• Simulation-based training enhances the success rate of applying CP.
• No participant reached the proficiency threshold for applying target CP forces.