Assessment of cricoid pressure application by emergency department staff

Clark, Rachel K; Trethewy, Christopher

doi:10.1111/j.1742-6723.2005.00760.x

Cited by 31 publications

(46 citation statements)

References 25 publications

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“…Similar results were presented in a study on Australian emergency physicians and nurses, as well as British anaesthetists [16,17]. Even worse results were reported by Guirro [18] on Brazilian anaesthetists, only 3.8% of whom knew the current recommendations regarding cricoid force in a rapid sequence induction intubation scenario [18].…”

Section: Discussionsupporting

confidence: 73%

Measurement of cricoid pressure force during simulated Sellick’s manoeuvre

Andruszkiewicz

Zawadka

Kosińska

et al. 2014

Anaesthesiol Intensive Ther

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Background: Cricoid pressure is a standard anaesthetic procedure used to reduce the risk of aspiration of gastric contents during the induction of general anaesthesia. However, for several years its validity has been questioned. There still remains the question of whether we perform it correctly. The aim of the study was an evaluation of the theoretical knowledge of Sellick's manoeuvre, as well an assessment of practical skill related with it when simulated on a model of the upper airway. Methods: The study was performed on a cohort of anaesthetists and anaesthetic nurses working in various hospitals in the Warsaw area. Measurements were taken on an upper airway model placed on an electronic kitchen scale. Participants were asked to perform Sellick's manoeuvre in the way they do it in their clinical practice. The test was done twice. Both the position and pressures applied on the model were documented. Knowledge concerning current recommendations of cricoid force was noted. Results: 206 subjects participated in the study. Only 49% (n = 101) properly identified cricoid cartilage during their application of Sellick's manoeuvre. Application of the correct pressure on the model of the airway was noted in 16.5% (n = 34) during the first attempt and in 20.4% (n = 42) during the second attempt. The median force applied during simulated Sellick's manoeuvre was 36 N (IQR: 26-55) in the first attempt, and 38 in the second attempt. Conclusions: Sellick's manoeuvre was performed incorrectly in many cases. Half of the participants of our study applied the pressure in the wrong place while the majority of them used an inappropriate amount of force. Thus, the application of cricoid pressure in patients should be preceded with simulation training.

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Section: Discussionsupporting

confidence: 73%

Measurement of cricoid pressure force during simulated Sellick’s manoeuvre

Andruszkiewicz

Zawadka

Kosińska

et al. 2014

Anaesthesiol Intensive Ther

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“…Seven randomized, controlled studies demonstrated that cricoid pressure can delay or prevent the placement of an advanced airway and that aspiration can occur despite application of pressure. 174 -180 Additional manikin studies [181][182][183][184][185][186][187][188][189][190][191][192][193][194] found training in the maneuver to be difficult for both expert and nonexpert rescuers. Neither expert nor nonexpert rescuers demonstrated mastery of the technique, and the applied pressure was frequently inconsistent and outside of effective limits.…”

Section: Cricoid Pressurementioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

702

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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“…Some publications, for example indicate that cricoid pressure is frequently incorrectly applied [85] so that a reliable closure of the esophagus by cricoid pressure cannot regularly be achieved [86,87] and muscle tone of the lower esophagus sphincter can be reduced by the maneuver [88]. In addition, the application of cricoid pressure can impede mask ventilation as well as direct and even indirect laryngoscopy [89].…”

Section: Securing the Airway In Patients With A Risk Of Aspirationmentioning

confidence: 99%