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TissueDB/Simulators/Emergency Department Thoracotomy Simulator (Misra)

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The Emergency Department Thoracotomy Simulator (Misra) is a low-cost bench-top task trainer for emergency department thoracotomy (EDT). EDT is the rapid bedside opening of the chest in a patient with profound refractory shock or recent loss of vital signs from penetrating thoracic injury. On the trainer a resident can practise the essential steps the authors designed it around: using the instruments and rib retractor on an anterolateral left thoracotomy, performing pericardiotomy with release of cardiac tamponade, and cross-clamping the descending aorta.[1]

Field Details
Features and Basic Operation Re-purposed commercial CPR mannequin torso for the chest shell, with a left-side anatomical rib set (left 4th–6th intercostal spaces) zip-tied in place. Handcrafted organ models fill the cavity: a foam-and-gauze lung, gauze-and-plastisol heart, aorta and esophagus, and paired plastisol skin and fat sheets. A shower cap filled with red-dyed fluid is tied to the heart to mimic cardiac tamponade, and an NG tube run through the esophagus lets the resident tell it apart from the aorta by feel. The cutaneous surface can carry a simulated penetrating wound; the skin/fat sheets and the tamponade shower cap are replaced between trainees for rapid reset.[1]
Current Development Status Built and evaluated in a single-centre randomized study with senior (PGY 3–5) general-surgery residents; face validity assessed; not clinically validated.[1]
Estimated Build Time and Cost ≈US$285 total in materials (Misra et al., Table 1); itemised per part in the tables below. Build and plastisol curing times are not stated in the source.[1]
Specialized Tools and Equipment In use, a standard emergency thoracotomy instrument tray with a rib retractor (operator-supplied; the source pairs the trainer with the institution's EDT instrument kit). Build uses ordinary hand tools, not specified in source.[1]
Version Version 1
Development Team Contact Information Misra A, Chapman A, Watson WD, Bach JA, Bonta MJ, Elliott JO, Dominguez EP — OhioHealth Riverside Methodist Hospital (Department of Medical Education; Trauma & Acute Care Surgery), Columbus, Ohio. Corresponding author: Asit Misra, asit.misra@med.miami.edu.[1]

Tissues

Tissue Qty Material Cost Notes
Lung 1 (left side) Soft packing foam (polymer not stated in source), gauze-wrapped and plastisol-coated — The visualisation target on chest entry; a soft-foam core gives lung-like bulk. Plastisol curing time not stated in source.[1]
Heart 1 Gauze cone, plastisol-coated — Primary target for pericardiotomy; the resident opens the pericardium to release the tamponade reservoir (covered in the Pericardium row).[1]
Pericardium 1 cap per run Disposable shower cap filled with red-dyed fluid, tied to the heart — Stands in for the tense, tamponade-filled pericardial sac; the source describes a red-dyed-fluid-filled shower cap tied to the heart and incised during pericardiotomy. Single-use per run.[1]
Aorta 1 Gauze cone, plastisol-coated — Target for descending-aorta cross-clamping. Same make-up as the esophagus, so the NG tube in the esophagus lets the resident tell the two apart by palpation.[1]
Esophagus 1 Gauze, plastisol-coated, with a clinical nasogastric (NG) tube inserted in the model — The NG tube is a deliberate tactile differentiator from the adjacent aorta during cross-clamping.[1]
Subcutaneous fat 10 pairs per gallon of plastisol Plastisol sheet, fat colour — Sits beneath the skin and, with it, forms the resealable chest-wall surface; made for rapid replacement between residents.[1]
Skin 10 pairs per gallon of plastisol Plastisol sheet, skin colour — The cutaneous surface for thoracotomy entry over the left 4th–6th intercostal spaces; paired skin/fat sheets for one-use-per-resident replacement.[1]


Structural Parts

Part Name Qty Material Cost Notes
CPR mannequin torso 1 Commercial CPR training mannequin (inventory unit) US$125 The outer chest shell. Standard internal parts are removed to make room for the organ models; an inventory unit was used, make/model not stated.[1]
Anatomical ribs (left side) 1 set (left 4th–6th intercostal space) 3B Scientific anatomical rib set US$72 Zip-tied to the shell at the left 4th–6th intercostal anchors; provides the intercostal landmark and the anchor against which the rib retractor is spread.[1]
Zip ties As required Plastic zip ties — Hold the rib set to the shell at the left 4th–6th intercostal anchors. Excluded from the Materials namespace per the structural-parts policy; recorded for build reproducibility.[1]
NG tube 1 Standard clinical NG (nasogastric) tube — Runs through the esophagus model so the resident can identify it by palpation and tell it apart from the aorta during cross-clamping. French size not stated in source.[1]
Packing foam block 2 Soft packing foam (polymer not stated in source); per-block size given in the build steps US$18 Structural substrate for the lung model (the trainer has one lung). The source buys two blocks because one gallon of plastisol makes about two lung/heart sets, so the spare covers a replacement.[1]
Disposable shower caps 20 (one per run) Standard plastic shower caps US$5 Each is filled with red-dyed fluid and tied to the heart for the tamponade reservoir (see the Pericardium row). Single-use per run.[1]
Liquid plastisol (medium density) 1 gallon per build Bait Plastics LLC medium-density liquid plastisol US$50 Makes most of the organ models — heart, lung, aorta, esophagus, fat, and skin coatings. One gallon is enough for 10 pairs of skin and fat plus two sets of lung and heart (Table 1). Not yet a TissueDB Materials page.[1]
Colour for skin and fat 2 × 4 oz bottles Plastisol colourant US$15 One bottle skin colour, one fat colour. Brand and colour codes not stated in source.[1]


Build Instructions

Phase 1: Prepare the chest shell

  1. Obtain a commercial CPR mannequin torso. The authors used an unused inventory unit; specific make and model are not stated.[1]
  2. Remove the mannequin's standard internal parts to make cavity space for the organ models (the source does not enumerate which parts).[1]
  3. Position the left-side anatomical rib set (3B Scientific) at the location of the left 4th, 5th, and 6th intercostal spaces; fix in place with zip ties at the anchor points.[1]

Phase 2: Fabricate the lung model

  1. Take one of the two soft packing foam blocks (16 in × 10 in × 4 in / 40.6 cm × 25.4 cm × 10.2 cm).[1]
  2. Handcraft the foam block into a lung shape (the source does not specify the method or tools).[1]
  3. Wrap the shaped foam in a layer of pink-coloured gauze.[1]
  4. Coat the gauze-wrapped foam with medium-density liquid plastisol (Bait Plastics LLC) for the surface feel and tissue characteristic described in Methods. Plastisol curing time is not stated.[1]

Phase 3: Fabricate the heart, aorta, and esophagus models

  1. Form gauze structures for the heart, aorta, and esophagus (the heart and aorta are described as cone-shaped; the esophagus shape is not specified in source).[1]
  2. Coat each gauze structure with medium-density liquid plastisol.[1]
  3. Insert a clinical NG (nasogastric) tube through the esophagus model lumen so it remains in place after coating. The NG tube serves as a tactile differentiator from the aorta during the procedure.[1]
  4. Fill a disposable shower cap with red-dyed artificial fluid and tie it to the heart model to simulate pericardial tamponade. Use one filled shower cap per training run.[1]

Phase 4: Fabricate the skin and subcutaneous fat sheets

  1. Pour medium-density liquid plastisol with skin-tone pigment into sheets sized 10 in × 18 in (≈25.4 cm × 45.7 cm). Allow to set (curing time not stated).[1]
  2. Pour medium-density liquid plastisol with fat-coloured pigment into sheets sized 10 in × 18 in (≈25.4 cm × 45.7 cm). Allow to set.[1]
  3. Produce ten pairs (skin + fat) per gallon of plastisol — enough for one initial build plus replacement skin/fat sheets across ten training runs.[1]

Phase 5: Assemble the trainer

The source does not detail the assembly sequence; arrange each completed model in its anatomical position within the mannequin shell, consistent with the left-side anterolateral thoracotomy approach.

  1. Place the lung model inside the chest cavity adjacent to the rib set, on the left side.[1]
  2. Place the heart model in the central mediastinal position with the shower-cap tamponade reservoir tied in place.[1]
  3. Lay the aorta and the esophagus (with NG tube) in the posterior mediastinum so the aorta is accessible to the descending-aorta cross-clamping technique and the NG tube distinguishes the esophagus by palpation.[1]
  4. Place a skin/fat pair across the left chest wall over the rib anchor area to form the cutaneous surface for the incision; a penetrating wound can be represented in this surface (Fig. 2F).[1]

Phase 6: Reset between training runs

  1. Replace the skin/fat pair from the previous run with a fresh pair.[1]
  2. Replace the shower-cap tamponade reservoir with a fresh shower cap filled with red-dyed fluid, and re-tie to the heart model.[1]
  3. Re-position any organ models displaced during the previous procedure.

Not Suitable For

The Misra EDT Simulator was designed around the essential steps of an anterolateral left thoracotomy: using the instruments and rib retractor, performing pericardiotomy with release of cardiac tamponade, and cross-clamping the descending aorta. Beyond that scope:

  • It is an anatomical, tactile model only; it does not reproduce physiology (no perfusion, pulse, respiratory motion, or haemodynamic feedback).[1]
  • In the source study, indication recognition was taught through discussion rather than on the trainer; pair the simulator with discussion-based scenario teaching to cover the decision to perform EDT.[1]
  • It was evaluated with PGY 3–5 senior general-surgery residents only (n = 9). Effectiveness has not been studied with junior residents, attending surgeons outside the institution, emergency-medicine learners, or pre-clinical medical students.[1]
  • The study was single-centre at OhioHealth Riverside Methodist Hospital, Columbus, Ohio; reproducibility outside the originating institution was not formally assessed. The published cost breakdown and material specifications are the principal mechanism the authors offer for external reproducibility.[1]
  • Familiarity bias is documented as a limitation: simulation-group residents practised on the trainer before being scored, which the authors note may inflate the observed effect size.[1]



References

[1]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 1.31 1.32 1.33 1.34 1.35 1.36 1.37 1.38 1.39 1.40 1.41 1.42 1.43 1.44 1.45 1.46 1.47 Misra A, Chapman A, Watson WD, Bach JA, Bonta MJ, Elliott JO, Dominguez EP (2024). "Use of Low-Cost Task Trainer for Emergency Department Thoracotomy Training in General Surgery Residency Program." Journal of Surgical Education 81(1):134–144. DOI: 10.1016/j.jsurg.2023.09.009. PMID: 37926660. © 2023 Association of Program Directors in Surgery, published by Elsevier Inc. All rights reserved.




Simulator data
Alternative names EDT Simulator; Low-Cost EDT Task Trainer (Misra)

Property "SimulatorProcedure" (as page type) with input value "Emergency Department Thoracotomy (EDT) — a rapid, lifesaving procedure performed at the bedside on trauma patients with profound refractory shock or recent loss of vital signs from penetrating thoracic injury. Technique typically uses an anterolateral left thoracotomy incision, with conversion to bilateral transverse thoracosternotomy ("clamshell") if right-chest access is needed. Enables pneumothorax relief, pericardial decompression of cardiac tamponade, direct control of intrathoracic hemorrhage, cross-clamping of the descending aorta and pulmonary hilum, open manual cardiac compression, and internal defibrillation.'"`UNIQ--ref-00000002-QINU`"'" contains invalid characters or is incomplete and therefore can cause unexpected results during a query or annotation process.


Page data
Keywords Emergency department thoracotomy, EDT, EDT trainer, anterolateral thoracotomy, clamshell thoracotomy, pericardiotomy, cardiac tamponade simulation, descending-aorta cross-clamping, pulmonary hilum cross-clamping, penetrating chest trauma, low-cost surgical simulator, plastisol simulator, CPR mannequin re-purposed, Misra 2024, general surgery residency, trauma training
SDG
Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 6 pages link here
Views 9 page views (analytics)
Created May 12, 2026 by Arturo Pelayo
Last edit June 12, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Emergency Department Thoracotomy Simulator (Misra)". Appropedia. Retrieved June 23, 2026.
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