USE OF A MECHANICAL SIMULATOR FOR TRAINING IN APPLYING CRICOID PRESSURE

Using an airway management training model, we have assessed anaesthesi a personnel in their use of correct cricoid force and ability to retai n this skill after a short training programme. A perspex device, worki ng on a hydraulic principle, was used to measure cricoid pressure when applied to the model. After initial assessment at two levels of crico id force (20 and 40 N), participants undertook additional training on 3 consecutive days. Thereafter, available participants underwent reass essment at 14-21 days. Forty-nine anaesthetic assistants and anaesthet ists underwent initial assessment and 18 completed the full training a nd reassessment. Untrained, the majority (63%) of participants applied inadequate cricoid force with a wide variation (mean 16.8 (SD 9.3) (r ange 4.5-43.0) at 20 N and 32.9 (13.3) (14.9-74) at 40 N). After a sin gle training session there was a marked improvement in application of cricoid force. Two additional training sessions did not provide furthe r improvement. After 14-21 days the ability of participants to apply c orrect cricoid force was retained by 72% of subjects. Those who applie d inadequate cricoid force initially were more likely to do so even af ter training. Most subjects applied too great a cricoid force in the f irst 5 s of application followed by a progressive loss of force during the next 20 s. This trend improved after training. We conclude that t he majority of untrained personnel apply inadequate cricoid force, pla cing patients at risk of aspiration of gastric contents. While a simpl e training programme improved application of cricoid force, retained f or up to 3 weeks, there was often a substantial decrease in the force applied to the cricoid during a single application, even after trainin g.