Sellick maneuver assisted real-time to achieve target force range in simulated environment-A prospective observational cross-sectional study on manikin

PLoS One. 2020 Feb 11;15(2):e0227805. doi: 10.1371/journal.pone.0227805. eCollection 2020.

Abstract

A force sensor system was developed to give real-time visual feedback on a range of force. In a prospective observational cross-section study, twenty-two anaesthesia nurses applied cricoid pressure at a target range of 30-40 Newtons for 60 seconds in three sequential steps on manikin: Group A (step 1 blinded, no sensor), Group B (step 2 blinded sensor), Group C (step 3 sensor feedback). A weighing scale was placed below the manikin. This procedure was repeated once again at least 1 week apart. The feedback system used 3 different colours to indicate the force range achieved as below target, achieve target, above target. Significantly higher proportion of target cricoid pressure was achieved with the use of sensor feedback in Group C; 85.9% (95%CI: 82.7%-88.7%) compared to when blinded from sensor in Group B; 31.3% (95%CI: 27.4-35.4%). Cricoid force achieved blind (Group B) exceeded force achieved with feedback (Group C) by a mean of 8.0 (95%CI: 5.9-10.2, p<0.0001) and 6.2 (95%CI:4.1-8.3, p< 0.0001) Newtons in round 1 and 2 respectively. Weighing scale read lower than corresponding force sensor by a mean of 8.4 Newtons (95% CI: 7.1-9.7, p<0.0001) in group B and 5.8 Newtons (95% CI: 4.5-7.1, p<0.0001) in Group C. Force sensor visual feedback system enabled application of reproducible target cricoid pressure with less variability and has potential value in clinical use. Using weighing scale to quantify and train cricoid pressure requires a review. Understanding the force applied is the first step to make cricoid pressure a safe procedure.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anesthesiology*
  • Biomechanical Phenomena
  • Computer Systems*
  • Cricoid Cartilage / physiology
  • Cross-Sectional Studies
  • Feedback
  • Female
  • Humans
  • Manikins*
  • Prospective Studies

Grants and funding

Funding of study was from National Health Innovation Centre (NHIC) Grant, Singapore. Grant number NHIC I2D 1409016. Development of novel ultrathin miniature force sensor to deliver optimal cricoid pressure for airway protection in patients at risk of gastric aspiration. Awardees of the grant were HI Hee as Principal Investigator, and CL Wong, O Wijeweera, BL Sng as investigating team members. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.