Sellick maneuver assisted real-time to achieve target force range in simulated environment-A prospective observational cross-sectional study on manikin.

Hwan Ing Hee,Chiong Ling Wong,Ban Leong Sng,Olivia Wijeweera,Rehena Sultana,Massimiliano Sorbello

doi:10.1371/journal.pone.0227805

Abstract

A force sensor system was developed to give real-time visual feedback on a range of force. In a prospective observational cross-section study, twenty-two anaesthesia nurses applied cricoid pressure at a target range of 30–40 Newtons for 60 seconds in three sequential steps on manikin: Group A (step 1 blinded, no sensor), Group B (step 2 blinded sensor), Group C (step 3 sensor feedback). A weighing scale was placed below the manikin. This procedure was repeated once again at least 1 week apart. The feedback system used 3 different colours to indicate the force range achieved as below target, achieve target, above target. Significantly higher proportion of target cricoid pressure was achieved with the use of sensor feedback in Group C; 85.9% (95%CI: 82.7%-88.7%) compared to when blinded from sensor in Group B; 31.3% (95%CI: 27.4–35.4%). Cricoid force achieved blind (Group B) exceeded force achieved with feedback (Group C) by a mean of 8.0 (95%CI: 5.9–10.2, p<0.0001) and 6.2 (95%CI:4.1–8.3, p< 0.0001) Newtons in round 1 and 2 respectively. Weighing scale read lower than corresponding force sensor by a mean of 8.4 Newtons (95% CI: 7.1–9.7, p<0.0001) in group B and 5.8 Newtons (95% CI: 4.5–7.1, p<0.0001) in Group C. Force sensor visual feedback system enabled application of reproducible target cricoid pressure with less variability and has potential value in clinical use. Using weighing scale to quantify and train cricoid pressure requires a review. Understanding the force applied is the first step to make cricoid pressure a safe procedure.

Highlights

Cricoid pressure is a common anaesthetic procedure during rapid sequence induction recommended by anaesthesia professional bodies [1,2], with more than 92% of British anaesthetists [3] using it in all emergency operations
We propose the use of real time objective feedback of cricoid pressure to guide the application of recommended target range of cricoid pressure
In this prospective exploratory study, we developed a force sensor system to measure force and give real-time visual feedback on the range of force attained during cricoid pressure

Summary

Introduction

Cricoid pressure is a common anaesthetic procedure during rapid sequence induction recommended by anaesthesia professional bodies [1,2], with more than 92% of British anaesthetists [3] using it in all emergency operations. Studies on the use of real-time force sensing feedback to guide the application of force in clinical situations is limited, tools studied to aid cricoid force application are bulky and not adopted in routine clinical setting [11, 14,15]. We propose the use of real time objective feedback of cricoid pressure to guide the application of recommended target range of cricoid pressure. In this prospective exploratory study, we developed a force sensor system to measure force and give real-time visual feedback on the range of force attained during cricoid pressure. The primary aim is to evaluate the efficacy of a force sensor system that gives real time visual feedback during simulated cricoid pressure application on manikin by anaesthesia nurses. We compared force measured with sensor and force transmitted inferiorly from manikin onto the weighing scale

Study design

Results

Discussion

Conclusion