TissueDB/Simulators/Massive Hemoptysis Simulator (New)

The Massive Hemoptysis Simulator (New) is an adult manikin-based airway trainer for practising how to manage massive (life-threatening) hemoptysis. An industrially 3D-printed (selective-laser-sintered) airway tree sits inside a repurposed intubation manikin. This trainer does not use locally available materials. The 3D-printed TPU airway tree replaces the manikin's internal airways. The tree includes the trachea, main bronchi, and segmental bronchi, and it derives from a deidentified CT scan. Peripheral IV catheters glued to selected segmental bronchi feed simulated blood from an external bag through roller-clamped tubing. A facilitator can therefore drive controllable bleeding into chosen airway segments. The trainer supports endotracheal and mainstem intubation, endobronchial blocker placement, and lateral decubitus positioning. It also supports bronchoscopic airway clearance with real clinical equipment. The authors developed it at the University of Colorado. A companion paper reports a curriculum built on it.^[1][2]

Source: New et al. 2024 (Chest); see References for the companion curriculum and digital-workflow papers.

1. Obtain a deidentified CT scan. Generate a digital 3D rendering of the main airways including trachea, bronchi, and segmental bronchi.^[1] The airway-tree model file appears in the paper's e-Appendix 1. Jacobson et al. 2023 describe the digital workflow.^[3]
2. Print the airway tree using an SLS printer (EOS P770, EOS) with EOS TPU 1301 powder (EOS). Note: this requires industrial SLS infrastructure, not consumer FDM equipment.^[1]

Verification checkpoint: Confirm that the printed airway tree includes trachea, bilateral main bronchi, and segmental bronchi. Confirm that the lumens are large enough to accept a standard bronchoscope.

1. Remove the internal manikin components in the chest cavity space, including the original manikin airways.^[1]
2. Seat the 3D-printed airway tree in the anatomically appropriate position just distal to the manikin vocal cords.^[1]
3. Fix the airway tree in place with adhesive glue.^[1]

Verification checkpoint: Confirm that a standard endotracheal tube advances through the manikin vocal cords into the 3D-printed trachea. Confirm that a bronchoscope navigates through the trachea into bilateral main bronchi and segmental bronchi.

1. Cut the catheters off peripheral IVs. Glue them to the ends of selected segmental bronchi bilaterally to create liquid channels for simulated bleeding.^[1]
2. Connect extension tubing to the IVs on the airway tree and extend to the outside of the manikin.^[1]
3. Attach a roller clamp to each extension tube to control the rate of bleeding into selected airways.^[1]
4. Prepare simulated blood. Mix 20 mL red food coloring, a few drops of blue food coloring, and 1 tablespoon of corn starch into a 1 L bag of normal saline or water. Agitate the bag to suspend the corn starch.^[1]
5. Connect the simulated blood bag to the external end of the extension tubing.^[1]

Verification checkpoint: Open a roller clamp. Confirm that simulated blood flows through the extension tubing, through the IV catheter, and into the targeted segmental bronchus. Confirm that the flow rate is controllable by adjusting the roller clamp. Verify there are no leaks at the catheter-bronchus junction.

• Double-lumen endotracheal tube placement training. Only 40% of content survey respondents selected this as important for massive hemoptysis. It is not a primary design target^[1]
• Electrocautery. Only 30% of respondents selected it. The paper's validation does not include it^[1]
• Learner groups beyond pulmonary and critical care medicine. The authors studied the simulator only with pulmonary and critical care medicine attendings and internal medicine residents. They did not assess suitability for other groups^[1]
• Chronic or low-volume hemoptysis — the simulator replicates the massive (life-threatening) hemoptysis scenario with active bleeding requiring immediate intervention^[1]