Systematic Review and Meta‐Analysis of Cricoid Pressure Training and Education Efficacy

Abstract

We examined the evidence on the effectiveness of education and training on cricoid pressure (ie, Sellick maneuver) application. Cricoid pressure is used during rapid sequence induction and intubation to reduce the risk of pulmonary aspiration. We searched seven databases for studies on the education and training of health care personnel expected to apply cricoid pressure as a part of their regular clinical responsibilities. We appraised the included studies using standardized tools validated for this purpose and we performed a meta-analysis of the eight eligible studies. The success rate for intubation increased after training according to the random effect model (95% CI = 0.157 to 0.452). Fisher's method combined probability test rejected the null hypothesis for patients (P = 4.93e-6), indicating that the application of cricoid pressure significantly improved after educational interventions. Regularly scheduled training in the application of cricoid pressure could sustain health care personnel's ability to apply effective cricoid pressure.

Cricoid Pressure: Contradictory Evidence Regarding a Standard Practice

“…6 Anesthesia professionals, hospital administrators, lawyers, and patients continue to accept cricoid pressure as a standard of care, especially for patients at high risk of regurgitation. 4,11,13 Therefore, health care providers should focus on improving their practice by developing curricula and creating skill-practice sessions to attain competency and improve patient outcomes. The controversy of employing or not employing cricoid pressure first requires that health care providers apply it correctly.…”

“…8,12,75 Authors of another study found that 69% of anesthesia professionals "had never heard of any recommended level of force to be used for the application of cricoid pressure" 76(p1212) on an awake, semiconscious, or unconscious patient; again, other authors have found similar results. 5,13,34,61 A 20-year-old study focused on perioperative nurses found that 95% of participants could not state the recommended pressure to be applied. 12 Other studies have found that, in general, health care providers of all types often do not provide cricoid pressure correctly.…”

“…2,9 Dr Brian Arthur Sellick's seminal work on cricoid pressure in the 1960s established the way the maneuver is performed; since the 1970s, the application of cricoid pressure has been accepted as a standard practice worldwide. 2,[10][11][12][13] Controversy does exist, however, because pulmonary aspiration can still occur even when cricoid pressure is applied. The question is: When pulmonary aspiration occurs, is it a result of the maneuver itself or the health care provider's improper technique?…”

Clinical Issues—May 2021

“…Simulated cricoid skill trainers, manikins, or digital scales can be effective tools for cricoid pressure training 6,9 . A systematic review evaluating the effectiveness of cricoid pressure training methods found consistent deficits in participants’ knowledge and abilities, and concluded that simulation methods were effective in improving knowledge of cricoid anatomy and the ability to apply the correct amount of pressure required.…”

“…A systematic review evaluating the effectiveness of cricoid pressure training methods found consistent deficits in participants’ knowledge and abilities, and concluded that simulation methods were effective in improving knowledge of cricoid anatomy and the ability to apply the correct amount of pressure required. Further, the authors acknowledged the valuable role that perioperative RNs play in preventing aspiration when assisting with intubation 9 …”