TissueDB/Simulators/Cricothyrotomy Simulator (White UW)

The Cricothyrotomy Simulator (White UW) is a low-cost cricothyrotomy trainer built from locally available materials — a 3D-printed ABS larynx, a cardboard trachea with compliant-foam rings and a bicycle-inner-tube skin on a wooden base — for practising anterior-neck landmark palpation and the open surgical-airway sequence.^[1] Conductive-foil sensors at six labelled landmarks on the trachea model record each instrument contact, so the site of each contact can be checked against the only correct landmark — the midline cricothyroid membrane (C). To use it, the trainee first watches an instructional video (New England Journal of Medicine), then palpates the cricothyroid membrane through the skin, makes a vertical skin incision and a horizontal 1 cm incision in the membrane, inserts a tracheal hook into the cricoid cartilage to open the airway, widens the opening with a hemostat, and places an endotracheal tube. ⚑ Open for review: this page and the D'Auria page describe one device from one source (D'Auria & Persia 2014) — whether to merge them (with D'Auria's scoring software as an overlay) or keep them split is routed to Catherine; do not merge without her ruling.

1. Print the cricoid and thyroid cartilages as a single rigid ABS assembly with a mobile cricothyroid joint. STL geometry, print settings, infill, supports, and ABS grade are not recoverable from the accessible secondary source (D'Auria & Persia, 2014)^[1] and remain OPEN pending access to the White et al. primary publications.
2. Fix the printed cartilages to a wooden base so they firmly support the trachea model.

1. Obtain a thin cardboard tube to serve as the tracheal wall, sized to an average adult trachea. The exact inner diameter, wall thickness, and length are not specified in accessible source.
2. Cut compliant-foam strips for the tracheal cartilaginous rings and attach them to the tube with appropriate spacing. Foam grade, ring count, and spacing are not specified in accessible source.
3. Apply conductive-foil strips to the six contact zones labelled A–F per D'Auria & Persia (2014) Figure 2: (A) posterior tracheal wall; (B) right and (D) left lateral trachea and cricothyroid membrane; (C) midline cricothyroid membrane (only correct incision site); (E) cricoid cartilage; (F) cartilaginous ring of the lower tracheal wall.

1. Assemble the ABS cartilage skeleton, cardboard tracheal tube, and foam cartilaginous rings into the cervical-anatomy stack on the wooden base.
2. Drape a segment of bicycle inner tube over the assembled stack to form the skin layer. Inner-tube size, grade, and tensioning method are not specified in accessible source.

1. Connect each of the six conductive-foil contact zones (A–F) to inputs on the Arduino Uno microcontroller board, and wire the procedure instruments into the same circuit so that touching a foil registers as a contact event. The detailed wiring layout is not specified in accessible source.
2. The Activity Detection Engine overlay — D'Auria & Persia (2014) Cyber Physical System scoring extension — is documented separately at TissueDB/Simulators/Cricothyrotomy Simulator (D'Auria).

• Palpate: thyroid cartilage, cricothyroid membrane, and cricoid cartilage identifiable through the bicycle-inner-tube skin — pass/fail
• Sensor continuity: touch each of the six foil zones (A–F) in turn and verify the Arduino registers contact — pass/fail
• Mobile joint: the cricothyroid joint flexes under palpation — pass/fail

The source's intended use procedure (D'Auria & Persia 2014, §2.2):

1. Before the first attempt, watch the New England Journal of Medicine instructional video.
2. Palpate the cricothyroid membrane; immobilise the larynx with the non-dominant hand and perform the procedure with the dominant hand.
3. Incise the skin (bicycle inner tube) vertically after palpating the membrane.
4. Incise the cricothyroid membrane on the trachea model horizontally (1 cm length).
5. Insert the tracheal hook into the cricoid cartilage.
6. Insert the hemostat and expand the airway opening vertically and horizontally.
7. Insert the endotracheal tube.

No Creative Commons licensed figure of this simulator is currently available. Secondary description figures in D'Auria & Persia (2014) are © IEEE All Rights Reserved. Readers with access to the White et al. 2012, 2013, or 2014 primary publications are invited to verify licensing and contribute a compatible image.

Further reading — University of Washington BioRobotics publications on this trainer. The three White et al. primaries are cited by D'Auria & Persia (2014) as the build source but were not independently accessed for this page:

• White L, Bly R, D'Auria D, Aghdasi N, Bartell P, Cheng L, Hannaford B. "Cricothyrotomy simulator with computational skill assessment for procedural skill training in the developing world." AAO-HNSF Annual Meeting and OTO Expo. 2013. DOI: 10.1177/0194599813495815a83.
• White L, Bly R, D'Auria D, Aghdasi N, Bartell P, Cheng L, Hannaford B. "Cricothyrotomy simulator with computational skill assessment for procedural skill training in the developing world." Journal of Otolaryngology – Head and Neck Surgery. 2014. (Citation as reported in D'Auria & Persia (2014); publication venue not independently verified.)
• White L, D'Auria D, Bly R, Bartell P, Aghdasi N, Jones C, Hannaford B. "Cricothyrotomy simulator training for the developing word" [sic]. 2012 IEEE Global Humanitarian Technology Conference (GHTC), Seattle, WA, October 2012.
• Aghdasi N, Bly R, White LW, Hannaford B, Moe K, Lendvay TS. "Crowd-sourced assessment of surgical skills in cricothyrotomy procedure." Journal of Surgical Research. 2015;196(2):302–306. DOI: 10.1016/j.jss.2015.03.018. PMID 25888499; PMC5945282. (A later crowd-sourced skill-assessment study of the same cricothyrotomy procedure from the same group.)