Assessment of Cricoid Pressure Application by Emergency Department Personnel

ABSTRACT

PURPOSE: To assess the knowledge and the accuracy of cricoid pressure applied by emergency department (ED) personnel. METHODS: A prospective, observational study was conducted for 100 ED personnel (57 doctors, 38 nurses, and 5 EMTs) who participated in emergency airway training courses. Each participant was asked to complete a knowledge survey and the accuracy of cricoid pressure applied was evaluated using the training manikin. Three attempts were measured and a mean value was calculated. Subgroup analysis was also performed for specific variables of interest. RESULTS: Only thirty-four participants (34%) applied adequate cricoid pressure, with all participants who were outside of the target range applying less than the target amount. No statistically significant difference was demonstrated for age, qualifications, years of experience, existence of prior instruction, accuracy in knowledge, or ability to apply cricoid force within the target range. Male participants applied correct cricoid pressure within the target range more often than females (p=0.035, odds ratio=6.987, CI:1.145-42.641). CONCLUSION: Both knowledge and the application of adequate cricoid pressure by ED personnel were inadequate. In particular, females more often applied low cricoid pressure in order to guard against regurgitation than did males. Repeated hands-on training is recommended using adequate methods that integrate the concept of force.