TissueDB/Simulators/Cricothyroidotomy Simulator (Gauger)

The Cricothyroidotomy Simulator (Gauger) is a low-cost, 3D-printed laryngotracheal trainer for emergency needle cricothyroidotomy on a paediatric airway. Needle cricothyroidotomy is the final, life-saving step when a patient cannot be intubated or oxygenated.^[1] The 3D-printed laryngotracheal model sits in a mannequin. A learner palpates the surface landmarks and inserts a 14-gauge Ravussin needle through the cricothyroid membrane into the trachea. The learner slides the cannula off the needle. The learner then delivers oxygen through the cannula with the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device.

Source — every material, build step and cost on this page is drawn from Gauger et al. 2018 unless a cell notes otherwise.

1. Obtain a laryngotracheal anatomical dataset and prepare it as a CAD model. Gauger et al. 2018 produces the model with CAD and 3D printing, citing Kovatch et al., reference [8], for the pipeline. The paper does not specify the source anatomy or the imaging modality used. A builder will need an institutional or local equivalent to reproduce the model.
2. Fabricate a 3D-printed laryngotracheal model from medical-grade silicone. Gauger 2018 names medical-grade silicone as the build material. The paper does not specify the exact silicone grade, durometer, printer system, slicing parameters, or the 3D-to-silicone route. A builder must select all of these locally.
3. Inspect the fabricated silicone model. Confirm that the cricothyroid-membrane region accepts a clean 14-gauge needle puncture. The target structure must yield cleanly to the Ravussin cannula for the oxygen-insufflation step to seat correctly.

1. Seat the 3D-printed silicone laryngotracheal model within the mannequin. Gauger 2018 describes the model as incorporated into a mannequin for procedural training.
2. Align the silicone model so that the cricothyroid-membrane region sits beneath the external skin at the anatomical midline. Learners palpate surface landmarks before needle insertion, and misalignment would invalidate the surface-anatomy training cue.
3. Confirm the trachea of the silicone model is open distally. An inserted cannula tip must sit freely in the tracheal lumen. Oxygen delivered through the Rapid-O2 device must vent freely into the trachea.

1. Fit an external skin layer over the laryngeal anatomy. Gauger et al. (2018), Figure 1, shows the model with its external skin removed to reveal the tracheal model. The deployed model carries an outer skin surface for landmark palpation.
2. Note that Gauger 2018 does not specify the skin's material. The paper does not state whether the skin is printed integrally or applied as a separate covering. It also does not state how the skin is secured or what the replacement protocol is. A builder will need to define these locally for reproducibility.

1. Connect the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device to an oxygen source, either wall oxygen or a portable cylinder. Gauger et al. 2018 does not specify the oxygen source. Set the device per the manufacturer's instructions. The Rapid-O2 device supplies the oxygen learners deliver after cannula placement.
2. Prepare a single-use 14-gauge Ravussin needle/cannula. Verify that the Rapid-O2 attachment port matches the cannula hub. A mismatched connector would block oxygen delivery.
3. Note for reproducibility: the source study supplied the Ravussin needle and Rapid-O2 device to learners inside a blue plastic bag. See Gauger et al. 2018, Figure 1. The paper describes no functional role for the bag.

1. Have the learner palpate the cricothyroid landmarks — the thyroid cartilage, cricothyroid membrane, and cricoid cartilage — on the model's external skin. Identifying the landmarks is the first step of the CSMP Checklist and the trainer's principal target. Gauger 2018 names only "identifies landmarks". These three are the standard front-of-neck-access landmarks, not separately enumerated by the source.
2. Have the learner attach a saline-filled syringe to the Ravussin cannula. Have the learner stabilize the cricothyroid with the non-dominant hand. The CSMP Checklist scores both steps before the learner inserts the needle.
3. Have the learner insert the 14-gauge Ravussin needle/cannula through the external skin and the silicone cricothyroid membrane. The needle tip enters the tracheal lumen. The learner aspirates throughout the insertion. The CSMP Checklist scores inserting through the cricothyroid membrane while aspirating.
4. Have the learner slide the cannula off the needle into the trachea. Have the learner withdraw the needle and leave the cannula in place. These are the cannula-seating and needle-removal steps of the CSMP Checklist.
5. Have the learner reconfirm position by aspirating air. Have the learner then stabilize/secure the cannula. The CSMP Checklist scores reconfirming position and securing the cannula before oxygenation.
6. Attach the Meditech Rapid-O2 device. Deliver oxygen through the cannula. This completes the front-of-neck oxygenation step that the trainer rehearses.

1. Reset the silicone laryngotracheal model between learners. Gauger et al. 2018 does not describe a replacement or cleaning protocol. Local practice will need to define whether to reuse the silicone and whether to replace the external skin layer. It must also define how to manage prior puncture sites.
2. If prior punctures compromise the external skin layer, it will likely need repair or replacement before the next learner. Gauger et al. 2018 describes no skin-replacement protocol.
3. Load a fresh 14-gauge Ravussin needle/cannula for each learner because the cannula is a single-use consumable.