Knowledge, attitudes, and practices regarding the Sellick maneuver among healthcare professionals in Bulgaria: a multicenter cross-sectional study

The Sellick Maneuver (SM) is used during Rapid Sequence Induction (RSI) to reduce the risk of regurgitation and Pulmonary Aspiration (PA); however, evidence regarding Bulgarian Healthcare Professionals' (HPs) preparedness to perform the SM is limited. This multicenter cross-sectional study assessed knowledge, attitudes, and practices (KAP) regarding the SM and factors associated with Adequate Self-Reported Practical Application (ASRPA). A total of 135 HPs from six Bulgarian institutions completed a 31-item, psychometrically evaluated Bulgarian-language questionnaire comprising Knowledge (15 items; 0-15), Attitudes (8 items; 8-40), and Practices (8 items; 8-40) domains. Internal consistency was assessed using KR-20 and Cronbach's α, factorability using the Kaiser-Meyer-Olkin (KMO) measure and Bartlett's test, and associated factors using multivariable logistic regression. Overall preparedness was moderate in 45.2%, good in 39.3%, and low in 15.6% of participants; 51.1% demonstrated ASRPA. Mean scores were 9.6 ± 3.1 for Knowledge, 30.2 ± 5.4 for Attitudes, and 26.7 ± 6.2 for Practices. Reliability was good for Knowledge (KR-20 = 0.82) and acceptable for Attitudes (α = 0.76) and Practices (α = 0.71). Knowledge demonstrated adequate factorability (KMO = 0.76; Bartlett's P < 0.001), with three factors explaining approximately 54% of variance. ASRPA was independently associated with non-Burgas institutional affiliation adjusted Odds Ratio (aOR), 1.76; 95% Confidence Interval (CI), 1.01-3.08), Previous SM Training (PSMT) (aOR, 1.94; 95% CI, 1.12-3.36), higher Knowledge scores (aOR, 1.15 per point; 95% CI, 1.05-1.27), and higher Attitudes scores (aOR, 1.11 per point; 95% CI, 1.02-1.21). Preparedness was predominantly moderate, supporting structured, simulation-enhanced, competency-based SM training. The Bulgarian KAP instrument showed promising preliminary psychometric properties but requires further independent validation.