Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care.

OBJECTIVE

To assess task training in cricoid pressure application suitable for incorporation into the algorithm for rapid sequence induction in acute care.

METHOD

A blinded prospective direct observational study of 110 critical care staff of two hospitals in regional New South Wales. Each participant was instructed to apply blinded cricoid force within the target range of 30-40 N to a cricoid model mounted on a weighing scale and the result recorded. After up to 3 min of unblinded practice without coaching on the same model a repeat blinded application of force was recorded. The pre- and post-intervention results were compared.

RESULTS

At the pre-intervention stage, 22 participants (20%) applied initial pressure within the target range, increasing to 57 (52%) at the post-intervention stage (chi(2) = 24.19, d.f. = 1, P < 0.01; odds ratio [OR] = 0.23; 95% confidence interval [CI] 0.12-0.44). The post-intervention results show a significant improvement in the number of participants achieving the target range in both nursing (chi(2) = 20.42, d.f. = 1, P < 0.01; OR = 0.18; 95% CI 0.08-0.42) and medical subgroups (chi(2) = 4.68, d.f. = 1, P = 0.03; OR = 0.34; 95% CI 0.11-1.02). The number applying force sufficient to prevent regurgitation, that is 30 N or greater, rose from 71 to 97 (65% to 88%) (chi(2) = 17.02, d.f. = 1, P < 0.01; OR = 0.24; 95% CI 0.11-0.51). The number applying in excess of 44 N fell from 41 to 25 (37% to 21%) (chi(2) = 5.54, d.f. = 1, P < 0.02; OR = 2.02; 95% CI 1.08-3.81).

CONCLUSION

The application of cricoid force by critical care staff can be significantly improved by up to 3 min of practice on a simple task trainer.