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Pressure to change: a low-cost anatomically accurate cricoid pressure simulator for just-in-time training
  1. Mark Parson,
  2. Nathaniel Duke
  1. Anaesthetics Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr Mark Parson, Anaesthetics Department, St Mary’s Hall, Eastern Rd, Brighton, BN2 5BE ; m.parson{at}


Cricoid pressure attempts to reduce the risk of aspiration during intubation. The technique is in routine use within the UK in line with current recommendations. Problems are often attributed to the application of an incorrect amount of force. Research has shown training to be limited in providing long-term benefit, with a skill retention period of <4 weeks. Using our previously created anatomically accurate comparatively low-cost cricoid pressure simulator, we have investigated the argument for cricoid pressure providers to perform just-in-time ‘self-calibration’ on a training device. The ‘Crikey Trainer’ device was used in four hospitals in South East England assessing 75 cricoid pressure providers. A structured interview examined: (1) cricoid pressure force before and after self-calibration; (2) associated skill knowledge; and (3) opinions on the device. 55% of participants successfully described cricoid ring location, 28% successfully described the force required. Difference between mean force and 30 Newton target improved in all groups after training (mean reduction 4.7N; p<0.0001). SD of measured force within each of the individual 30s tests reduced from an average of 3.0N (CI 2.62 to 3.36) to 2.09 (CI 1.75 to 2.42; p<0.0001). 97.3% of participants would consider using the device pre-Rapid Sequence Induction (RSI). We have developed an accurate cricoid pressure training device and improved cricoid pressure application force and variation. The data we and others have collected suggest that there is a place for regular pre-RSI self-calibration and that the majority of cricoid pressure providers would be receptive to it.

  • cricoid pressure
  • sellick
  • cricoid
  • rsi
  • anaesthesia
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  • Contributors MP and ND have made significant contributions to this work during device creation, data collection, data analysis and write-up as based on the International Committee of Medical Journal Editors Recommendations 2013.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The development costs of ‘Crikey Trainer’ were funded by the authors of this study. The Crikey Trainer is not currently commercially available, however, the authors are currently seeking a manufacturer interested in mass producing the device.

  • Ethics approval No ethics approval was needed for this project. Decision made by Scott Harfield, Head of Research & Development, Brighton & Sussex University Hospitals NHS Trust (

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data include years of clinical experience of subject. Additional data are only available to the authors.

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