TissueDB/Simulators/Paediatric Airway Management Trainer (Carter)

The Paediatric Airway Management Trainer (Carter) is a three-dimensional (3D) printed paediatric tracheal model — printed from the trachea to the carina — for paediatric airway management training (Carter et al. 2020).^[1] It is derived from CT imaging of a 4 kg five-month-old infant and printed on a Stratasys Polyjet J750 at 14-micron layers in the Agilus30 photopolymer, the final-production material selected for greater tissue fidelity. It supports four uses: emergency front-of-neck access (CICO) training for anaesthetic consultants and registrars across neonates, infants and small children; rigid bronchoscopic training; shared anaesthesia–otolaryngology airway planning from pathological airway models; and age- or pathology-specific configurations printed 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]).

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, so institutional or local equivalent imaging is required for reproduction.^[1]
2. Segment the airway from the CT volume in 3D Slicer to create a 3D mesh of the trachea down to the carina.^[1]
3. Refine the mesh in Zbrush and Meshmixer to produce a 3D-printable file with appropriate wall thickness and feature continuity.^[1]
4. Run the mesh through Netfabb to detect and correct mesh errors before submission to the printer.^[1]

1. Configure the print on a Stratasys Polyjet J750 (Stratasys, Rehovot, Israel) at 14-micron layer resolution to obtain the layer fidelity reported by the authors.^[1]
2. Print the final model in Stratasys Agilus30 photopolymer; Carter 2020 selected Agilus30 over the Vero and Tango photopolymers trialled at varying shore hardnesses (rigid to soft and flexible) because it produced greater tissue fidelity.^[5][1][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]

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, operated by a consultant otolaryngologist.^[1]
2. Insert the rigid bronchoscope to confirm intratracheal visualisation of the lumen; Carter 2020 shows the expected tracheal view.^[1]
3. Advance to the bifurcation to confirm carinal visualisation; Carter 2020 shows the expected carinal view.^[1]

1. Present the model with the front-of-neck training adjuncts required by the local CICO protocol; Carter 2020 names CICO training as the primary use case but does not specify the adjuncts used.^[1]
2. Provide the model to the ENT department for repeated rigid bronchoscope navigation practice, per the Wellington Hospital ENT bronchoscopy interest reported by Carter 2020.^[1]
3. Request a custom configuration via the authors' print-and-post service (jeremy.young@ccdhb.org.nz); Carter 2020 invites readers to send data files — airway pathologies for planning, or age-specific CICO models — to be printed and posted.^[1]