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TissueDB/Simulators/Cricothyrotomy Simulator (Calvo)

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Anatomical reference diagram of the larynx showing the thyroid cartilage, cricothyroid membrane, cricoid cartilage and trachea, with the cricothyrotomy access site.
Anatomical reference showing the laryngeal structures (thyroid cartilage, cricothyroid membrane, cricoid cartilage, trachea) and the cricothyrotomy access site. Image by PhilippN, CC BY-SA 3.0 via Wikimedia Commons. Anatomical reference only — not a figure from Calvo et al. 2021.

The Cricothyrotomy Simulator (Calvo) is a low-cost airway trainer: a 3D-printed trachea covered with pork belly. It trains emergency surgical cricothyrotomy in a "can't intubate, can't oxygenate" situation.[1] A learner palpates the laryngeal landmarks through the pork-belly skin. The learner then incises over the cricothyroid membrane to reach the airway. When the learner pierces the membrane, the model lets air escape and bleeds at the incision. It modifies the REAL CRIC Trainer (Kei et al. 2019). Ultrasound can also identify the laryngeal landmarks on the model.

Field Details
Features and Basic Operation The learner palpates the laryngeal landmarks, incises the skin over the cricothyroid membrane, and enters the airway; on entry air escapes at the membrane and the cut bleeds. An instructor controls the air and bleeding remotely — a foot air pump and a pressurised blood circuit — keeping their hands free during the team scenario. The landmarks can also be identified by ultrasound.
Current Development Status Built and evaluated in a single-centre observational study (expert and participant ratings). Not clinically validated.
Estimated Build Time and Cost
US$260
Not stated by Calvo et al. 2021.
Specialized Tools and Equipment Spinal-block needle protective sleeve, used to tunnel the IV set through the pork belly. Access to a 3D printer to print the REAL CRIC trachea STL (airwaycollaboration.org). An ultrasound machine for the optional ultrasound landmark-identification use. Probe type not specified by Calvo et al. SimMon vital-signs software on an iPad controlled from an iPhone, for the multidisciplinary scenario only.
Version Modified REAL CRIC Trainer as described in Calvo et al. 2021.
Development Team Contact Information Andrea Calvo (corresponding, macalvo@clinic.cat), Cristina Ibañez Esteve, Lidia Gomez-Lopez, Juan Manuel Perdomo, Raquel Berge, Carmen Gomar Sancho — SimClinic Group, Department of Anesthesia and Intensive Care, Hospital Clínic, University of Barcelona, Spain. Victor Varela — Department of Anesthesia and Intensive Care, Hospital Clínico de las Fuerzas Aéreas, Chile (Calvo et al. 2021).

Source — every material, build step and cost on this page is drawn from Calvo et al. 2021 unless a cell notes otherwise.

Tissues

Tissue Qty Material Cost Notes
Skin 1 pork-belly slab Pork belly — Pork-belly skin layer over the 3D-printed trachea. The learner palpates and incises this surface.
Subcutaneous tissue 1 integrated (same slab) Pork belly — Subcutaneous layer of the same pork-belly slab, infiltrated with simulated blood and tunnelled for the bleeding circuit.
Thyroid cartilage 1 integrated 3D-printed trachea (print material not specified) — Palpable superior landmark of the cricothyroid membrane.
Cricoid cartilage 1 integrated 3D-printed trachea (print material not specified) — Palpable inferior landmark of the cricothyroid membrane.
Cricothyroid membrane 1 integrated 3D-printed trachea (print material not specified) — Target structure of the procedure. This is the incision site, where air escapes on entry.
Trachea 1 integrated 3D-printed trachea (print material not specified) — Downstream airway lumen. The air pump feeds air in through an endotracheal tube, so the air escapes at the cricothyroid membrane on entry.


Structural Parts

Part Name Qty Material Cost Notes
High-fidelity simulator (mannequin) neck 1 (reusable) Commercial high-fidelity patient simulator (type/brand not stated) — The phantom attaches to a high-fidelity simulator's neck for the multidisciplinary CICO scenario.
Endotracheal tube (ETT) 1 Endotracheal tube — Air-input line: it sits in the 3D-printed trachea and connects to the foot air pump. Pump-driven air escapes at the cricothyroid membrane when the learner pierces it.
Air pump (foot-operated) 1 Manual foot-operated air pump — The instructor operates it by foot, away from the participant. It delivers air through the ETT, so air escapes at the cricothyroid membrane on entry. Replaces the original RCT's Ambu bag.
Blood-delivery line 1 IV infusion set — Distal end tunnelled into the pork belly beyond the incision line. Proximal end on the pressurised bag.
Pressuriser with red-stained saline bag 1 Saline bag stained red with food dye, mounted in an IV pressuriser — Squeezes the bag to push the red-stained saline through the tunnelled IV set at constant pressure, freeing the instructor's hands. Replaces the original RCT's hand-squeezed bag.
Paper tape As needed Paper surgical tape — Seals the distal exit of the 3D-printed trachea. Pump-driven air then escapes at the cricothyroid-membrane puncture, not the open distal end.
Trachea fastener As needed Foam adhesive tape — Fastens and secures the 3D-printed trachea.


Build Instructions

Phase 1: Print and prepare the 3D trachea

  1. Print the 3D trachea from the published REAL CRIC STL file (https://airwaycollaboration.org/3d-cric-trainer-1/). Calvo et al. 2021 reproduce the original REAL CRIC trachea from this file. The paper does not specify the print material, the printer or the slicing parameters. Select them locally.
  2. Seal the distal exit of the printed trachea with paper tape. Pump-driven air then escapes at the cricothyroid-membrane puncture rather than the open distal end (Calvo et al. 2021, Fig 1D).
  3. Fasten and secure the 3D-printed trachea with foam adhesive tape (Calvo et al. 2021, Fig 1E).

Phase 2: Prepare the air circuit


Illustration of an endotracheal tube.
Endotracheal tube (ETT), illustrative. Calvo et al. (2021) place an ETT inside the 3D-printed trachea and connect it to the foot air pump so that air escapes at the cricothyroid membrane when it is pierced (Fig 1B–C, F). Image by BruceBlaus, CC BY-SA 4.0 via Wikimedia Commons.
  1. Place an endotracheal tube inside the 3D-printed trachea. Calvo et al. route the air supply through an ETT seated in the model (Calvo et al. 2021, Fig 1B–C).
  2. Connect the foot-operated air pump to the ETT. In the modified model, an air pump replaces the original Ambu bag. The instructor operates the pump by foot, away from the participant. The model then releases air at the cricothyroid membrane when the learner pierces it (Calvo et al. 2021, Fig 1F).


Phase 3: Prepare the blood circuit

  1. Stain a 1 L bag of saline red with food dye. Calvo et al. use red-stained saline as the simulated blood (Calvo et al. 2021).
  2. Mount the saline bag in an IV pressuriser. In the modified model, the pressuriser replaces the hand-squeezed bag of the original RCT. It delivers a greater, constant pressure and frees the instructor's hands (Calvo et al. 2021, Fig 1J).
  3. Connect the IV infusion set to the bag. The set carries the simulated blood to the tunnelled outlet in the pork belly (Calvo et al. 2021, Fig 1J).

Phase 4: Prepare the pork belly


A raw pork-belly slab with the skin on.
Raw pork-belly slab with skin on, illustrative. Calvo et al. (2021) cover the 3D-printed trachea with a pork-belly slab as the skin-and-subcutaneous layer and infiltrate its subcutaneous tissue with simulated blood (Fig 1G) before assembly. Image by Jonathunder, CC BY-SA 3.0 via Wikimedia Commons.
  1. Obtain a pork-belly slab with the skin intact, sized to cover the 3D-printed trachea. The pork belly forms the skin and subcutaneous layers the learner incises. Calvo et al. do not give specific dimensions. Follow the original REAL CRIC specification (Kei et al. 2019).[2]
  2. Infiltrate the subcutaneous tissue of the pork belly with the simulated blood. The saturated tissue produces visible bleeding when the learner incises the skin (Calvo et al. 2021, Fig 1G).
  3. Tunnel the distal end of the IV infusion set through the subcutaneous layer. Use the protective plastic sleeve of a spinal-block needle. Advance the tunnel beyond the planned incision line. In the original RCT, tissue resistance at a shallow tunnel could exceed the blood pressure and block the outlet. The longer tunnel lowers resistance, so blood reaches the incision (Calvo et al. 2021, Fig 1H–I).


Phase 5: Assemble and verify


A high-fidelity training mannequin head and neck.
High-fidelity training mannequin (head and neck), illustrative. Calvo et al. (2021) attach the 3D-printed trachea phantom to a high-fidelity simulator's neck for the multidisciplinary CICO scenario. Image by aorta, CC BY 2.0 via Wikimedia Commons.
  1. Place the prepared pork belly over the 3D-printed trachea, skin surface outward, with the trachea centred beneath the tissue. This reproduces the skin–soft-tissue–airway relationship the learner palpates and incises (Calvo et al. 2021).
  2. Connect the tunnelled IV outlet in the pork belly to the pressurised saline bag (Calvo et al. 2021, Fig 1J).
  3. Attach the assembled phantom to a high-fidelity simulator's neck for the multidisciplinary scenario. Calvo et al. integrate the model on a high-fidelity simulator neck for the CICO simulation (Calvo et al. 2021).
  4. Palpate through the pork belly to confirm the build. The thyroid cartilage and cricoid cartilage landmarks on the 3D-printed model must be identifiable through the overlying tissue. Then charge the blood pressuriser and have the instructor operate the foot air pump. Confirm that blood reaches the incision and that air escapes at the cricothyroid membrane on entry.

Build reference: Figures 1A–1K in Calvo et al. (2021) show the assembly sequence. The plate covers the 3D trachea, ETT placement, sealing the distal exit with paper tape, fastening with foam adhesive tape, the air-pump connection, pork-belly blood infiltration, tunnelling with the spinal-block needle protector, IV-set placement, and the final phantom. The figures are published under CC BY-NC-ND 4.0 and are not reproduced here. See the open-access article for the figure plate.

Reset / Between learners

  1. Replace the pork-belly slab when prior incisions compromise its skin. The pork belly is a consumable layer. Calvo et al. do not state a reuse count.
  2. Refill the simulated-blood bag and re-tunnel the IV outlet for each fresh pork-belly slab. Operational step: Calvo et al. do not describe a reset protocol.
  3. Inspect the reusable 3D-printed trachea. Re-seal its distal exit with paper tape if the seal is broken. Operational step: not specified by Calvo et al.



References

[2]

  1. ↑ Calvo A, Ibañez Esteve C, Varela V, Gomez-Lopez L, Perdomo JM, Berge R, Gomar Sancho C. Design, application and evaluation of a cricothyrotomy model for a multidisciplinary simulation. An observational single centre study. Educación Médica 2021;22:305–310. DOI: 10.1016/j.edumed.2020.12.003.
  2. ↑ 2.0 2.1 Kei J, Mebust DP, Duggan LV. The REAL CRIC Trainer: Instructions for Building an Inexpensive, Realistic Cricothyrotomy Simulator With Skin and Tissue, Bleeding, and Flash of Air. Journal of Emergency Medicine 2019;56(4):426–430. DOI: 10.1016/j.jemermed.2018.12.023. PMID: 30685221.



Simulator data
Alternative names Modified REAL CRIC Trainer


Page data
Keywords cricothyrotomy, CICO, emergency airway, surgical simulation, 3D printed trachea, pork belly, REAL CRIC Trainer, Calvo, Barcelona, ultrasound, TissueDB
SDG
Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 15 pages link here
Redirects TissueDB/Simulators/Calvo Cricothyrotomy Simulator
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Created April 10, 2026 by Arturo Pelayo
Last edit July 27, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Cricothyrotomy Simulator (Calvo)". Appropedia. Retrieved August 3, 2026.
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