TissueDB/Simulators/Paediatric Airway Management Trainer (Carter)

The Paediatric Airway Management Trainer (Carter) is a high-cost (industrially 3D-printed) paediatric tracheal model — produced on a Stratasys Polyjet J750 photopolymer printer rather than from locally available materials, though the authors present it as an economically viable alternative to commercial paediatric airway models — for neonatal, infant and small-child airway management training, including emergency front-of-neck access in can't intubate, can't oxygenate (CICO) scenarios.^[1] It was developed at Wellington Regional Hospital with the Victoria University of Wellington School of Design, derived from CT imaging of a 4 kg five-month-old infant and printed from the trachea to the carina; as a next development step the authors plan to compare its distensibility against animal cadaveric models. To date the authors have demonstrated it only for rigid bronchoscopic examination — carinal and tracheal views were recorded by a consultant otolaryngologist; they additionally intend it for emergency front-of-neck access training of anaesthetic consultants and registrars across neonates, infants and small children, propose it for shared anaesthesia–otolaryngology airway planning from pathological airway models, and invite custom age- or pathology-specific prints on request. It sits within the TissueDB airway cluster alongside the Gauger^[2] and Kei^[3] trainers, both cited in Carter 2020 (refs [3] and [6]).

Source — every material, build step and cost statement on this page is drawn from Carter et al. 2020 unless a cell notes otherwise. Related TissueDB airway trainers: Aho, Calvo, D'Auria, Muller, Kovatch and Qaim Ali.

1. Acquire CT imaging data of a paediatric patient appropriate to the target training population. Carter et al. 2020 derived their reference model from a 4 kg five-month-old infant. Reproduction therefore needs institutional or local equivalent imaging.
2. Segment the airway from the CT volume in 3D Slicer. Create a 3D mesh of the trachea down to the carina.
3. Refine the mesh in Zbrush and Meshmixer to produce a 3D-printable file with appropriate wall thickness and feature continuity.
4. Run the mesh through Netfabb to detect and correct mesh errors before submission to the printer.

1. Configure the print on a Stratasys Polyjet J750 (Stratasys, Rehovot, Israel) at 14-micron layer resolution. This setting gives the layer fidelity the authors report.
2. Print the final model in Stratasys Agilus30 photopolymer. Carter 2020 trialled the Vero and Tango photopolymers at varying shore hardnesses, from rigid to soft and flexible. The authors selected Agilus30 because it produced greater tissue fidelity.^[5][4]
3. Print the model using the J750's full-colour, variable-density and flexible-property single-object capability. Carter 2020 does not enumerate per-region material settings, support material, or build time.

1. Position the printed model on a stable surface compatible with rigid bronchoscope insertion. Carter 2020 used a Storz Hopkins (Karl Storz Endoscopy Australia, Macquarie Park, NSW) telescope, 0°, 4 mm. A consultant otolaryngologist operated it.
2. Insert the rigid bronchoscope. Confirm that the lumen is visible inside the trachea. Carter 2020 shows the expected tracheal view.
3. Advance the bronchoscope to the bifurcation. Confirm that the carina is visible. Carter 2020 shows the expected carinal view.

1. Present the model with the front-of-neck training adjuncts that the local CICO protocol requires. Carter 2020 names CICO training as the primary use case. It does not specify the adjuncts.
2. Give the model to the ENT department for repeated rigid bronchoscope navigation practice. Carter 2020 reports the Wellington Hospital ENT interest in bronchoscopy that motivates this step.
3. Request a custom configuration through the authors' print-and-post service (jeremy.young@ccdhb.org.nz). Carter 2020 invites readers to send data files for printing and posting. These files cover airway pathologies for planning, or age-specific CICO models.