A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure

We describe the development and laboratory assessment of a refined prototype tactile feedback device for the safe and accurate application of cricoid pressure. We recruited 20 operating department practitioners and compared their performance of cricoid pressure on a training simulator using both the device and a manual unaided technique. The device significantly reduced the spread of the applied force: average (SE) root mean squared error decreased from 8.23 (0.48) N to 5.23 (0.32) N (p < 0.001). The average (SE) upwards bias in applied force also decreased, from 2.30 (0.74) N to 0.88 (0.48) N (p < 0.01). Most importantly, the percentage of force applications that deviated from target by more than 10 N decreased from 18% to 7% (p < 0.01). The device requires no prior training, is cheap to manufacture, is single‐use and requires no power to operate, whilst ensuring that the correct force is always consistently applied.

[1]  Cricoid compression is effective in obliterating the esophageal lumen in the presence of a nasogastric tube. , 1985, Anesthesiology.

[2]  I. Power,et al.  Cricoid pressure impedes placement of the laryngeal mask airway. , 1995, British journal of anaesthesia.

[3]  D. Chassard,et al.  Cricoid Cartilage Pressure Decreases Lower Esophageal Sphincter Tone , 1997, Anesthesiology.

[4]  G. Shorten.  Airway obstruction from cricoid pressure. , 1993, Anesthesia and analgesia.

[5]  R. Taylor,et al.  Analysing Deviation-From-Target Data: Applying the Correct Force in Sellick’s Maneuver , 2015, Journal of biopharmaceutical statistics.

[6]  S. Fletcher,et al.  Fracture of the cricoid cartilage after Sellick's manoeuvre. , 1996, British journal of anaesthesia.

[7]  R. Vanner,et al.  The effect of cricoid pressure and neck support on the view at laryngoscopy , 1997, Anaesthesia.

[8]  T. Short,et al.  Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS) , 1999, Anaesthesia.

[9]  H. Owen,et al.  Learning to apply effective cricoid pressure using a part task trainer , 2002, Anaesthesia.

[10]  A. Babu.  Cricoid pressure. , 2006, Journal of perioperative practice.

[11]  B. J. Pryle,et al.  Regurgitation and Esophageal Rupture with Cricoid Pressure: A Cadaver Study , 1993 .

[12]  P. Good.  Permutation, Parametric, and Bootstrap Tests of Hypotheses , 2005 .

[13]  S. Doherty,et al.  Effectiveness of cricoid pressure in preventing gastric aspiration during rapid sequence intubation in the emergency department: study protocol for a randomised controlled trial , 2012, Trials.

[14]  T. Clayton,et al.  A novel method of measuring cricoid force. , 2002, Anaesthesia.

[15]  M. Cowie.  National Institute for Health and Care Excellence. , 2015, European heart journal.

[16]  S. Ralph,et al.  Rupture of the oesophagus during cricoid pressure , 1991, Anaesthesia.

[17]  B. Sellick.  Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. , 1961, Lancet.

[18]  H. Owen,et al.  Learning on a simulator does transfer to clinical practice. , 2009, Resuscitation.

[19]  T. Meek,et al.  Cricoid pressure: can protective force be sustained? , 1998, British journal of anaesthesia.

[20]  G. L. Fanning.  The efficacy of cricoid pressure in preventing regurgitation of gastric contents. , 1970, Anesthesiology.

[21]  L. Gemmel,et al.  The cricoid yoke--a device for providing consistent and reproducible cricoid pressure. , 1986, British journal of anaesthesia.

[22]  C. Trethewy,et al.  Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care , 2007, Emergency medicine Australasia : EMA.

[23]  E. Crosby,et al.  No evidence for decreased incidence of aspiration after rapid sequence induction , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[24]  R. Walker,et al.  Effect of cricoid force on airway calibre in children: a bronchoscopic assessment. , 2010, British journal of anaesthesia.

[25]  D. Cook,et al.  Cricoid pressure training using simulation: a systematic review and meta-analysis. , 2013, British journal of anaesthesia.

[26]  R. Bannister.  CHRONIC AUTONOMIC FAILURE WITH POSTURAL HYPOTENSION , 1979, The Lancet.

[27]  P. Choi,et al.  Cricoid Pressure Displaces the Esophagus: An Observational Study Using Magnetic Resonance Imaging , 2003, Anesthesiology.

[28]  C. Trethewy,et al.  Assessment of cricoid pressure application by emergency department staff , 2005, Emergency medicine Australasia : EMA.

[29]  A. Garrard,et al.  The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients , 2004, Anaesthesia.

[30]  J. Duggan,et al.  Intragastric pressure and its relevance to protective cricoid force * , 2003, Anaesthesia.

[31]  J. Lerman.  On cricoid pressure: "may the force be with you". , 2009, Anesthesia and analgesia.

[32]  P. Brisson,et al.  Variable application and misapplication of cricoid pressure. , 2010, The Journal of trauma.

[33]  O. Nafiu,et al.  Knowledge, attitude, and practice regarding cricoid pressure of ED personnel at a large U.S. teaching hospital. , 2009, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[34]  L. Thibodeau,et al.  Incidence of aspiration after urgent intubation. , 1997, The American journal of emergency medicine.

[35]  Andy Parry.  Teaching anaesthetic nurses optimal force for effective cricoid pressure: a literature review. , 2009, Nursing in critical care.

[36]  K. Allman.  The effect of cricoid pressure application on airway patency. , 1995, Journal of clinical anesthesia.

[37]  M. J. Rice,et al.  Cricoid Pressure Results in Compression of the Postcricoid Hypopharynx: The Esophageal Position Is Irrelevant , 2009, Anesthesia and analgesia.

[38]  D. Zideman,et al.  Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. , 2007, Annals of emergency medicine.