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77 A pressure to change: using a cricoid pressure mannequin to improve confidence in cricoid pressure application by reaffirming skills immediately pre-induction
  1. MI Parson1,
  2. N Duke2
  1. 1East Sussex Healthcare Trust, UK
  2. 2Western Sussex Hospitals, UK

Abstract

Background The anaesthetic technique of cricoid pressure has recently had renewed recommendation for consideration by the Difficult Airway Society in both adult and obstetric populations. Efficacy continues to be a topic of debate despite routine use.1 Theoretical problems (including imperfect laryngoscopic view, oesophageal rupture and airway obstruction) are often attributed to the application of an incorrect amount of force.2 Cricoid pressure training devices are effective, however training benefits wear off within four weeks.3

Training devices currently available are either high-fidelity but expensive and bulky, preventing frequent use, or cheap but low-fidelity, reducing effectiveness. We argue habitual self-assessment immediately before anaesthetic induction would minimise the issues above.

Methodology We have previously developed a compact, high-fidelity cricoid pressure training device using new technologies including 3D printers and programmable microprocessors. This device was placed in the anaesthetic room of an emergency (NCEPOD) theatre, and assessed using a structured interview/assessment focussing on:

  • Pressure technique improvement in the context of pre-RSI device utilisation and,

  • Opinions from a variety of grades of Anaesthetic Doctor, ITU nurses and ODPs

Results 100% of ODPs and ITU nurses said they would consider using the device to reaffirm skills pre-induction and 89% showed improvement in pressure application accuracy. ODPs revealed the device was “Realistic” and was “Great for keeping up to date with skills”. Anaesthetic colleagues stated “It improves assurance in the team skill-set”.

Conclusion We have designed and built a cost-effective method of providing cricoid pressure self-assessment immediately pre-induction improving accuracy in pressure application and confidence by all team members.

A mass-produced a version could be expected to cost less than half the currently available high-fidelity devices allowing every NCEPOD theatre and ITU department to afford a device to facilitate pre-RSI cricoid pressure optimisation to allow effective oesophageal occlusion whilst maintaining optimal intubating conditions.

References

  1. Cook TM. The cricoid debate – balancing risks and benefits. Anaesthesia 2016;71:721–722. doi: 10.1111/anae.13492

  2. Vanner RG, Asai T. Editorial: Safe Use of Cricoid Pressure. Anaesthesia 1999;54:1–3.

  3. Johnson RL, Cannon EK, Mantilla CB, Cook DA. Cricoid pressure training using simulation: a systematic review and meta-analysis. Brit J Anaesth 2013;111:338–?46.

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