TissueDB/Simulators/Cricothyrotomy Simulator (Muller)

The Cricothyrotomy Simulator (Muller) is an open surgical cricothyrotomy training setup built around a commercially available Strategic Operations Inc. 3-in-1 TCCC patient simulator.^[1] The reusable commercial manikin is fitted with replaceable low-cost layers: porcine skin provides the external incision surface and a 3-inch Microfoam surgical-tape patch on the removable laryngeal insert represents the cricothyroid membrane. The trainee performs the scalpel–finger–bougie sequence and advances a cuffed #6 endotracheal tube into the manikin airway.

This page describes preparation and reset of a purchased commercial simulator host. Muller et al. (2020) is not a design or manufacturing specification for the Strategic Operations manikin.

1. Obtain a Strategic Operations Inc. 3-in-1 TCCC patient simulator.
2. Remove the manikin's laryngeal insert to access the internal airway assembly.
3. Apply a fresh 3-inch 3M Microfoam surgical-tape patch to the laryngeal insert at the cricothyroid-membrane location.
4. Apply a light coating of Surgilube to the internal model structures to reduce artificial friction.
5. Reinstall the laryngeal insert.
6. Place a fresh section of porcine skin over the external laryngeal structures to provide the skin-incision surface.

Source boundary: the publication describes preparation of the commercial manikin but does not provide instructions for manufacturing the manikin itself.

1. Provide a new #10 disposable scalpel for the participant.
2. Provide a serviceable bougie airway introducer.
3. Provide a serviceable #6 cuffed endotracheal tube.
4. Provide a serviceable 10 cc syringe.
5. Apply a light coating of Surgilube to the distal portion of the #6 endotracheal tube.

1. Palpate the external neck landmarks.
2. Incise the porcine-skin surface.
3. Incise the Microfoam-tape cricothyroid-membrane layer.
4. Introduce the bougie through the opening into the airway.
5. Advance the #6 cuffed endotracheal tube over the bougie in the caudal direction.
6. Position the cuff fully within the tracheal airway.
7. Inflate the cuff with the 10 cc syringe.

The bougie-assisted technique used by Muller et al. derives from the scalpel–finger–tube method described by Paix and Griggs.^[2]

Muller et al. defined successful performance as correct caudal placement of the #6 cuffed endotracheal tube through the cricothyroid membrane, with the cuff fully within the trachea and inflated within the study's 3-minute time limit.

The removable internal components of the manikin allow direct visual confirmation of tube placement.

This is a study performance criterion, not a fabrication-quality criterion for the simulator.

1. Remove and discard the used porcine-skin section.
2. Remove the laryngeal insert.
3. Remove and discard the incised Microfoam-tape patch.
4. Apply a fresh 3-inch Microfoam-tape patch.
5. Reapply Surgilube to the internal manikin structures.
6. Reinstall the laryngeal insert.
7. Place a new porcine-skin section over the external neck.
8. Deflate and remove the endotracheal tube and bougie.
9. Inspect the bougie, endotracheal tube and syringe and retain them for reuse only if serviceable.
10. Provide a fresh #10 disposable scalpel to the next participant.

Editorial note: the exact deflation, withdrawal and serviceability-inspection sequence above makes the reset operationally explicit. Muller et al. states that the bougie, endotracheal tube and syringe were reused if serviceable but does not prescribe every reset action as a formal checklist.

Muller et al. reports that, with one existing manikin and a qualified trainer, US$35 of expendable supplies could support training of 10 medics in 2–3 hours.^[3]

The US$35 value must not be interpreted as:

• the purchase price of the Strategic Operations manikin;
• the cost of constructing the complete simulator;
• the cost of one training attempt; or
• a total-build estimate derived from the individual line items.

• The Strategic Operations 3-in-1 TCCC manikin is a commercial host and is not fabricated by this method.
• The source does not report the manikin acquisition cost.
• The simulator provides Skin, Cricothyroid Membrane and Trachea representations relevant to the task.
• No Muller Bronchial Tissue representation is supported.
• The porcine-skin field does not reproduce active traumatic bleeding.
• The study measured procedural training performance, not independent simulator fidelity or clinical outcome validity.