Assessment of cricoid pressure application by emergency department staff

Abstract

To assess the accuracy of cricoid force applied by ED staff working in two hospitals based on the New South Wales central coast. A prospective, observational study of 38 doctors and 69 nurses working in the ED. Each staff member was asked to demonstrate cricoid pressure using a model based on a set of weighing scales. Five attempts were measured and a mean value calculated for each participant. Subgroup analysis was also performed for specific variables of interest. Twenty-seven (25%) participants applied the target cricoid force. Of the 80 participants who were outside of the target range, 50 (63%) applied less than the target range and 30 (37%) applied more than the target range. No statistically significant difference was demonstrated for sex, age, qualification or years of experience and the ability to apply cricoid force within the target range. More candidates (27) applied the target range than those who correctly identified it (12). When methods of instruction were compared there was no difference between candidates with one and more than one modality of instruction (t-test: t (105) = -0.09, P = 0.9; 95% confidence interval [CI]-0.66-0.6) and the mean cricoid force applied. Those who had greater than one form of instruction applied correct cricoid force at the target range more often than those who had received only one form of instruction, this result was significant. (chi(2) = 4.24, d.f. = 1, P = 0.04; odds ratio = 2.6; 95% CI 1.03-6.41). The application of cricoid force by ED staff participating in the present study is unreliable, often providing inadequate protection against regurgitation. Training using a model integrating the concept of force is recommended. The role of cricoid pressure in rapid sequence induction needs to be further investigated.