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TissueDB/Simulators/Cricothyrotomy Simulator (Muller)

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▼This page was built from limited source data.Strategic Operations 3-in-1 TCCC manikin unit price (not published by manufacturer), the exact porcine skin cut (belly, shoulder, or other) and fixation method, the #6 ETT cuff inflation volume, laryngeal insert construction details, and Figure 2 hero image licensing (pending a visual check that the extracted PDF image carries no Oxford University Press typesetting overlay) are not resolved by Muller et al. 2020. See references. Build instructions and material specifications may be incomplete. If you have access to the source publication, please help improve this page.


General Information

Strategic Operations Inc. 3-in-1 TCCC training manikin with a section of porcine skin draped over the external laryngeal structures of the neck.
Figure 2 from Muller et al. 2020 (US Government public domain): the simulator substrate — Strategic Operations Inc. 3-in-1 TCCC manikin with porcine skin placed over the laryngeal structures.

This simulator trains open surgical cricothyrotomy using the scalpel–finger–bougie technique on U.S. Army first responders. A commercial Strategic Operations Inc. 3-in-1 TCCC manikin provides the airway and neck anatomy; a 3-inch 3M Microfoam tape patch adhered to the internal laryngeal insert simulates the cricothyroid membrane as a cuttable surface; a section of porcine skin placed over the external laryngeal structures provides the scalpel incision surface; and Surgilube coats the internal model structures and the distal portion of the #6 cuffed endotracheal tube to reduce artificial manikin friction. The design was evaluated in a randomized prospective observational study (Muller et al., Military Medicine, 2020, DOI: 10.1093/milmed/usaa035).

Field Details
General Information Low-cost cricothyrotomy training modality built around a commercial Strategic Operations Inc. 3-in-1 TCCC manikin. The cricothyroid membrane is simulated by a 3-inch 3M Microfoam tape patch adhered to the internal laryngeal insert (a removable modular component of the manikin), and a section of porcine skin is placed externally over the laryngeal structures to provide the scalpel incision surface. Internal model structures and the distal portion of the #6 cuffed endotracheal tube are lightly coated with Surgilube to reduce artificial manikin friction. Developed and tested by Muller and colleagues (Madigan Army Medical Center and Special Warfare Medical Group) to train U.S. Army First Responders (68W combat medics and Special Operations Combat Medics) in the scalpel–finger–bougie open cricothyrotomy technique. Evaluated in a randomized prospective observational study published in Military Medicine (2020). Source: Muller et al., Military Medicine, 2020.
Features and Basic Operation Not stated in source
Current Development Status Peer-reviewed validation. Randomized prospective observational study (Joint Base Lewis-McChord, May–September 2016; Madigan IRB approved) of 67 U.S. Army first responders (37 × 68W combat medics + 30 Special Operations Combat Medics), evaluated at baseline and after a half-day training session. Training Group success rate improved from 76.5% to 100% versus 72.7% to 84.8% in Control (McNemar P = 0.008). The 68W Training Group benefited most, with a 23% average success-rate improvement and a 21-second reduction in time-to-correct-placement (33% improvement over baseline[1]). At 120-day retest (n = 37, 54% retention), no statistically significant skill degradation was observed (McNemar P = 0.250). Published in Military Medicine 185(9–10):e1779–e1786, September–October 2020 (PMID 32567654).
Estimated Build Time and Cost Not specified in source. Half-day training block (approximately 2–3 hours for a cohort of 10 medics) is specified for the training component (Muller et al. 2020, p. e1786); per-manikin preparation time is not itemised., Per-attempt consumables (Muller et al. 2020, p. e1781): US$0.12 Microfoam tape patch + US$0.25 Surgilube coating + US$1.00 porcine skin section + US$1.49 new #10 scalpel. US$35 total expendable supply cost trains a cohort of 10 medics over 2–3 hours (Muller et al. 2020, Abstract and Conclusion, p. e1786). The Strategic Operations Inc. 3-in-1 TCCC manikin reusable base price is not quoted in the source; manufacturer quotation required. Reusable items (Bougie US$5.49, #6 cuffed ETT US$1.49, 10 cc syringe US$0.67) are checked between participants for serviceability and reused if serviceable (Muller et al. 2020, p. e1781).
Specialized Tools and Equipment Not stated in source
Version Not stated in source
Development Team Contact Information Not stated in source

Tissues

Tissue Qty Material Cost Notes
Skin 1 section per session Porcine skin (cross-referenced to pork belly; paper specifies only "porcine skin" — exact cut not disambiguated in source) US$1.00 per session (Muller et al. 2020, p. e1781) Placed externally over the laryngeal structures of the Strategic Operations 3-in-1 TCCC manikin. Consumable — new section applied each reset.
Cricothyroid membrane 1 patch per session 3-inch 3M Microfoam surgical tape adhered to the internal laryngeal insert (modular removable component of the Strategic Operations 3-in-1 TCCC manikin) US$0.12 per patch (Muller et al. 2020, p. e1781) Placement is internal to the laryngeal insert, not external to the neck. Provides the cuttable surface the trainee must incise to reach the simulated airway. Fresh patch applied each reset.
Trachea 1 integrated Integrated airway structure of the Strategic Operations 3-in-1 TCCC manikin Included in manikin base (not separately priced) Success criterion requires the cuff of a caudally oriented #6 ETT to sit fully in the trachea and be inflated within the time limit (Muller et al. 2020, p. e1782).
Thyroid cartilage 1 integrated Integrated palpable landmark of the Strategic Operations 3-in-1 TCCC manikin Included in manikin base (not separately priced) Palpable superior landmark adjacent to the cricothyroid membrane. The half-day training included an airway-anatomy review with hands-on palpation and identification of the cricothyroid membrane (Muller et al. 2020, p. e1782).
Cricoid cartilage 1 integrated Integrated palpable landmark of the Strategic Operations 3-in-1 TCCC manikin Included in manikin base (not separately priced) Palpable inferior landmark adjacent to the cricothyroid membrane. The half-day training included an airway-anatomy review with hands-on palpation and identification of the cricothyroid membrane (Muller et al. 2020, p. e1782).


Structural Parts

Part Name Qty Material Cost Notes
Strategic Operations Inc. 3-in-1 TCCC manikin 1 Commercial Tactical Combat Casualty Care (TCCC) training manikin, 3-in-1 variant, with removable laryngeal insert Manufacturer quotation required (not published in source) Reusable base providing airway, neck, palpable cartilage landmarks, and a removable laryngeal insert for internal Microfoam tape placement (Muller et al. 2020, p. e1781, Fig. 2). Supplied by Strategic Operations Inc.
3M Microfoam surgical tape, 3-inch 1 patch per session 3M Microfoam tape, 3-inch width US$0.12 per patch (Muller et al. 2020, p. e1781) Adhered to the internal laryngeal insert to simulate the cricothyroid membrane. Replaced each reset.
Surgilube surgical lubricant 1 coating per session Surgilube or equivalent sterile surgical lubricant US$0.25 per coating (Muller et al. 2020, p. e1781) Applied to internal model structures and to the distal portion of the #6 cuffed ETT to reduce artificial manikin friction during advancement. Re-applied each reset.
Disposable scalpel, #10 blade 1 per participant (new each) #10 disposable scalpel, single-use US$1.49 per participant (Muller et al. 2020, p. e1781) Used for the initial vertical skin incision and the horizontal membrane incision in the scalpel–finger–bougie technique. Fresh blade issued to each trainee.
Bougie airway introducer 1 (reused if serviceable) Bougie US$5.49 per unit (Muller et al. 2020, p. e1781) Passed through the incised cricothyroid membrane to guide ETT placement. Checked between participants and reused if serviceable per Muller protocol.
Cuffed endotracheal tube, #6 1 (reused if serviceable) #6 cuffed endotracheal tube (ETT), caudally oriented for successful placement[1] US$1.49 per unit (Muller et al. 2020, p. e1781) Railroaded over the bougie into the airway. Success criterion: caudally oriented #6 cuffed ETT passes through the cricothyroid membrane with the cuff fully in the trachea and inflated within the time limit (Muller et al. 2020, p. e1782). Distal portion coated with Surgilube before each attempt. Checked between participants and reused if serviceable.
10 cc syringe 1 (reused if serviceable) Standard 10 cc syringe US$0.67 per unit (Muller et al. 2020, p. e1781) Used to inflate the ETT cuff after placement. Checked between participants and reused if serviceable.


Build Instructions

The paper's half-day training protocol (presentation, anatomy review, palpation practice, technique demonstration citing Paix and Griggs 2012, twice-supervised practice) is pedagogical content and is documented separately in the associated SELF Module (not on this build page).

Phase 1: Prepare the manikin

  1. Obtain a Strategic Operations Inc. 3-in-1 TCCC manikin patient simulator because the paper evaluates its airway geometry as the simulation substrate (Muller et al. 2020, p. e1781, Fig. 2).
  2. Remove the laryngeal insert from the manikin to expose the internal airway structures, because the paper confirms the manikin allows easy removal of internal parts for placement verification (p. e1781).
  3. Adhere a 3-inch 3M Microfoam tape patch to the laryngeal insert at the cricothyroid membrane location because this simulates the cricothyroid membrane as the cuttable surface (p. e1781).
  4. Coat the internal model structures with a light film of Surgilube because this reduces artificial manikin friction during ETT advancement (p. e1781).
  5. Reinsert the laryngeal insert into the manikin body.
  6. Place a new section of porcine skin over the laryngeal structures at the external neck because this provides the scalpel incision surface for the vertical skin incision of the scalpel–finger–bougie technique (p. e1781).

Phase 2: Prepare consumables per trainee

  1. Issue one new #10 disposable scalpel per participant because each participant must receive a fresh blade (Muller et al. 2020, p. e1781).
  2. Inspect the bougie for serviceability and lay out for reuse because the paper reuses the bougie across participants if serviceable (p. e1781).
  3. Inspect the #6 cuffed ETT for serviceability and lay out for reuse because the paper reuses the ETT across participants if serviceable (p. e1781).
  4. Inspect the 10 cc syringe for serviceability and lay out for reuse because the paper reuses the syringe across participants if serviceable (p. e1781).
  5. Coat the distal portion of the #6 cuffed ETT with a light film of Surgilube because this reduces artificial manikin friction during advancement through the membrane (p. e1781).

Phase 3: Reset between trainees

  1. Remove and discard the used porcine skin section from the external neck of the manikin.
  2. Remove the laryngeal insert from the manikin body and discard the used Microfoam tape patch.
  3. Adhere a fresh 3-inch 3M Microfoam tape patch to the laryngeal insert at the cricothyroid membrane location.
  4. Re-coat the internal model structures with a light film of Surgilube.
  5. Reinsert the laryngeal insert into the manikin body.
  6. Place a new section of porcine skin over the laryngeal structures at the external neck.
  7. Inspect the bougie, #6 cuffed ETT, and 10 cc syringe for serviceability; retain for reuse if serviceable, replace if not.
  8. Issue a fresh #10 disposable scalpel to the next participant.

Phase 4: Success verification

  1. Confirm success by verifying that a caudally oriented #6 cuffed ETT has passed through the cricothyroid membrane with the cuff fully in the trachea and inflated within the time limit (Muller et al. 2020, p. e1782).
  2. Remove internal manikin parts to visually confirm ETT placement, because the paper uses direct visualization as the verification method (p. e1782).

Checkpoint: Readiness verification

  1. Confirm the manikin laryngeal insert is fitted with a fresh 3M Microfoam tape patch — pass/fail.
  2. Confirm the internal model structures and the distal portion of the ETT are coated with Surgilube — pass/fail.
  3. Confirm a new porcine skin section is placed over the external laryngeal structures — pass/fail.
  4. Confirm a fresh #10 scalpel is issued to the current participant — pass/fail.
  5. Confirm the bougie, #6 cuffed ETT, and 10 cc syringe are serviceable — pass/fail.



References

[1][2]

  1. ↑ 1.0 1.1 1.2 Muller KL, Facciolla CA, Monti J, Cronin A. "Impact of Succinct Training on Open Cricothyrotomy Performance: A Randomized, Prospective, Observational Study of U.S. Army First Responders." Military Medicine. 2020;185(9–10):e1779–e1786. DOI: 10.1093/milmed/usaa035. PMID 32567654.
  2. ↑ Paix BR, Griggs WM. "Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple 'scalpel-finger-tube' method." Emergency Medicine Australasia. 2012;24(1):23–30. DOI: 10.1111/j.1742-6723.2011.01510.x. PMID 22313556. (Cited as Muller reference 30; the originating "scalpel-finger-tube" method that Muller adapted to the "scalpel-finger-Bougie" variant.)




Simulator data



Page data
Keywords cricothyrotomy, open surgical airway, scalpel finger bougie, TCCC manikin, Strategic Operations, 3M Microfoam tape, laryngeal insert, porcine skin, Surgilube, U.S. Army 68W, Special Operations Combat Medic, SOCM, Madigan, Muller, TissueDB
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Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 2 pages link here
Redirects TissueDB/Simulators/Muller Cricothyrotomy Simulator
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Created April 10, 2026 by Arturo Pelayo
Last edit May 18, 2026 by StandardWikitext bot
Cite as Arturopelayo (2026). "TissueDB/Simulators/Cricothyrotomy Simulator (Muller)". Appropedia. Retrieved June 4, 2026.
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