Use of a mechanical simulator for training in applying cricoid pressure

Area of Science:

• Anesthesiology
• Airway Management
• Medical Education

Background:

• Cricoid force application is crucial in airway management to prevent aspiration.
• Previous studies indicate variability and inadequacy in cricoid pressure application by healthcare professionals.
• The effectiveness of training interventions on cricoid force application skills requires further investigation.

Purpose of the Study:

• To assess the accuracy of cricoid force application by anesthesia personnel.
• To evaluate the impact of a short training program on cricoid force application skills.
• To determine the retention of cricoid force application skills over time.

Main Methods:

• Utilized an airway management training model with a hydraulic perspex device to measure cricoid pressure.
• Assessed 49 anesthesia assistants and anesthetists on cricoid force application at 20 N and 40 N.
• Provided training over 3 consecutive days with reassessment at 14-21 days for 18 participants.

Main Results:

• Initially, 63% of participants applied inadequate cricoid force with significant variation.
• A single training session markedly improved cricoid force application, with no further gains from additional sessions.
• Skill retention was observed in 72% of participants at 14-21 days, though initial inadequacy predicted later performance.
• Participants often applied excessive initial force with a subsequent decrease, a trend improved by training.

Conclusions:

• The majority of untrained anesthesia personnel apply inadequate cricoid force, posing an aspiration risk.
• A simple training program effectively improves cricoid force application and skill retention for at least three weeks.
• Despite training, a decrease in applied force during a single application was noted, highlighting the need for ongoing reinforcement.