TissueDB/Simulators/Emergency Department Thoracotomy Simulator (Misra)
General Information
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. A re-purposed CPR mannequin torso forms the shell; handcrafted plastisol-coated organ models (heart, lung, aorta, esophagus, fat, and skin) fill the cavity and are made for quick replacement between trainees. A resident can practise the anterolateral left thoracotomy, conversion to clamshell, pericardiotomy with tamponade release, descending-aorta cross-clamping, and open cardiac compression. Total reproduction cost is about US$285.[1]
| Field | Details |
|---|---|
| General Information | A bench-top EDT task trainer. The shell is a re-purposed CPR mannequin torso fitted with a left-side anatomical rib set. Handcrafted gauze-and-plastisol models for the heart, lung, aorta, esophagus, fat, and skin fill the cavity and reset quickly between trainees.[1] |
| Features and Basic Operation | Re-purposed CPR mannequin shell with a left-side rib set and handcrafted heart, lung, aorta, esophagus, and paired skin/fat models. The skin/fat sheets and the shower-cap tamponade reservoir are replaced between trainees for rapid reset.[1] |
| Current Development Status | Built and tested; shown validity in a study with senior general-surgery residents.[1] |
| Estimated Build Time and Cost | Not stated in source; the paper gives no aggregate build time or plastisol curing time.[1], Approximately US$285.[1] |
| Specialized Tools and Equipment | Mostly hand tools for shaping the foam lung and casting the plastisol sheets. In use, standard thoracotomy instruments including a Finochietto rib retractor (operator-supplied).[1] |
| Version | Not stated in source |
| Development Team Contact Information | Misra A, Chapman A, Watson WD, Bach JA, Bonta MJ, Elliott JO, Dominguez EP — Department of Medical Education and Trauma & Acute Care Surgery, OhioHealth Riverside Methodist Hospital, Columbus, Ohio.[1] |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Lung | 1 (left side) | Polyurethane packing foam, gauze-wrapped and plastisol-coated | ~US$9 (foam) + shared plastisol | The visualisation target on chest entry; a 40.6 × 25.4 × 10.2 cm foam core gives lung-like bulk. Plastisol curing time not stated in source.[1] |
| Heart | 1 | Gauze cone, plastisol-coated | From shared US$50 plastisol | Primary target for pericardiotomy, direct cardiac compression, and internal defibrillation. The tamponade reservoir is covered in the Pericardium row.[1] |
| Pericardium | 1 cap per run | Disposable shower cap filled with red-dyed fluid, tied to the heart | ~US$5 per 20 caps | Stands in for the tense pericardium; releasing it during pericardiotomy gives the visual and tactile cue of tamponade decompression. Single-use per run.[1] |
| Aorta | 1 | Gauze cone, plastisol-coated | From shared US$50 plastisol | 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 cone, plastisol-coated, with a clinical NG tube through the lumen | From shared US$50 plastisol | The NG tube is a deliberate tactile differentiator from the adjacent aorta during cross-clamping.[1] |
| Subcutaneous fat | 10 pairs per gallon | Plastisol sheet with fat-coloured pigment | From shared US$50 plastisol + pigment | Sits beneath the skin and, with it, forms the resealable chest-wall surface (sheets ~25.4 × 45.7 cm); made for rapid replacement between residents.[1] |
| Skin | 10 pairs per gallon | Plastisol sheet with skin-tone pigment | From shared US$50 plastisol + pigment | The cutaneous surface for thoracotomy entry over the left 4th–6th intercostal spaces; paired skin/fat sheets (~25.4 × 45.7 cm) 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 re-purposed) | ~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 | Provides the rib-retractor anchor and the intercostal landmark; zip-tied to the shell so the cage holds during retraction without metal-on-metal feel.[1] |
| Zip ties | As required | Standard plastic cable ties | Not itemised in source | 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 | Not itemised in source | 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 (one per lung model) | Polyurethane packing foam, 40.6 × 25.4 × 10.2 cm per block | ~US$18 (two blocks) | Structural substrate for the lung model; a structural fill rather than a tissue analogue in its own right.[1] |
| Disposable shower caps | 20 (one per run) | Standard plastic shower caps | ~US$5 (20 caps) | 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 (1 gallon) | Makes most of the organ models — heart, lung, aorta, esophagus, fat, and skin coatings. One gallon supplies a full build plus replacement skin/fat across about ten runs. Not yet a TissueDB Materials page.[1] |
| Pigment for skin and fat | 2 × 4 oz / 118 mL bottles | Plastisol pigment / colourant | ~US$15 (two bottles) | One bottle skin-tone, one fat colour. Brand and colour codes not stated in source.[1] |
Build Instructions
Phase 1: Prepare the chest shell
- Obtain a commercial CPR mannequin torso. The authors used an unused inventory unit; specific make and model are not stated.[1]
- Remove the standard internal parts (sternum block, pulmonary mechanics module, any internal hardware) to create cavity space for the organ models.[1]
- 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
- Take one of the two packing foam blocks (16 in × 10 in × 4 in / 40.6 cm × 25.4 cm × 10.2 cm).
- Handcraft the foam block into a lung shape using a knife or shears (specific cut pattern not provided in the paper).[1]
- Wrap the shaped foam in a layer of pink-coloured gauze to represent visceral pleura colouration.
- 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
- Form a cone-shaped structure from gauze, sized appropriately for each organ (heart, aorta, esophagus — three separate gauze cones; dimensions not specified in Methods).[1]
- Coat each gauze cone with medium-density liquid plastisol.
- 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]
- 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
- 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]
- 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]
- 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
- Place the lung model inside the chest cavity adjacent to the rib set, on the left side (consistent with the anterolateral left thoracotomy approach).[1]
- Place the heart model in the central mediastinal position with the shower-cap tamponade reservoir tied in place.[1]
- Lay the aorta cone in the posterior mediastinal position so it is accessible to the descending-aorta cross-clamping technique.[1]
- Lay the esophagus cone (with NG tube) adjacent to the aorta in the posterior mediastinum.[1]
- Place a skin/fat pair across the left chest wall over the rib anchor area to form the cutaneous surface for the incision.[1]
Phase 6: Reset between training runs
- Replace the skin/fat pair from the previous run with a fresh pair.[1]
- Replace the shower-cap tamponade reservoir with a fresh shower cap filled with red-dyed fluid, and re-tie to the heart model.[1]
- Re-position any organ models displaced during the previous procedure.
Not Suitable For
The Misra EDT Simulator trains the technical sequence of an anterolateral left thoracotomy and its conversion to clamshell as needed, with cross-clamping of the descending aorta and pulmonary hilum, pericardiotomy with cardiac tamponade decompression, and open cardiac compression. Beyond that scope:
- It does not simulate physiological response — there is no perfusion, no pulse, no respiratory motion, no haemodynamic feedback. The trainer is anatomical and tactile only.[1]
- It does not simulate pre-arrival decision-making (the Western Trauma Association indications algorithm). Trainers should pair this simulator with discussion-based scenario teaching to cover indication-criteria recognition.[1]
- It was validated 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 validation study was single-centre at OhioHealth Riverside Methodist Hospital, Columbus, Ohio; reproducibility outside the originating institution has not been 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 had practised on the trainer in Phase 1 before being scored in Phase 2, which the authors note may inflate the observed effect size relative to a true blinded comparison.[1]
References
- ↑ 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.
| Alternative names | EDT Simulator; Low-Cost EDT Task Trainer (Misra); OhioHealth EDT Trainer |
|---|
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.
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Emergency Department Thoracotomy Simulator (Misra)". Appropedia. Retrieved June 4, 2026. |