Anatomical reference showing the laryngeal structures (thyroid cartilage, cricothyroid membrane, cricoid cartilage, trachea) and the cricothyrotomy access site. Image by PhilippN, CC BY-SA 3.0 via Wikimedia Commons. Anatomical reference only — not a figure from Gauger et al. 2018.

The Cricothyroidotomy Simulator (Gauger) is a low-cost, 3D-printed laryngotracheal trainer for emergency needle cricothyroidotomy on a paediatric airway. Needle cricothyroidotomy is the final, life-saving step when a patient cannot be intubated or oxygenated.[1] The 3D-printed laryngotracheal model sits in a mannequin. A learner palpates the surface landmarks and inserts a 14-gauge Ravussin needle through the cricothyroid membrane into the trachea. The learner slides the cannula off the needle. The learner then delivers oxygen through the cannula with the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device.

Field Details
Features and Basic Operation A 3D-printed laryngotracheal model with a removable external skin layer (shown removed in Fig 1), reproducing the front-of-neck landmarks and the cricothyroid-membrane access site for needle cricothyroidotomy practice.
Current Development Status A single-institution pre/post resident-training study evaluated this simulator. The study did not separately validate the simulator's own fidelity.
Estimated Build Time and Cost
Not stated in source
Specialized Tools and Equipment 14-gauge Ravussin needle/cannula; Meditech Rapid-O2 Cricothyroidotomy Insufflation Device; saline-filled syringe (per the CSMP Checklist, for aspiration during cannula insertion); 3D-printing access for medical-grade silicone (CAD/3D-print pipeline per Gauger 2018, citing Kovatch et al.).
Version First reported version published in Gauger et al. 2018.
Development Team Contact Information Virginia T. Gauger (corresponding; Department of Anesthesiology, Michigan Medicine, University of Michigan; vthompso@med.umich.edu); Deborah Rooney (Department of Learning Health Sciences, Michigan Medicine); Kevin J. Kovatch (Department of Otolaryngology Head & Neck Surgery, Michigan Medicine); Lauren Richey (Department of Anesthesiology, Michigan Medicine); Allison Powell (University of Michigan); Hailesllassie Berhe (St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia); David A. Zopf (Department of Otolaryngology Head & Neck Surgery, Michigan Medicine).

Tissues

Tissue Qty Material Cost Notes
Skin 1 skin layer per session (or as reused) External skin layer of the model, shown removable in Fig 1. Material not specified by Gauger 2018. — Outer skin surface over the laryngeal landmarks.
Cricothyroid membrane 1 integrated Integrated region of the 3D-printed medical-grade silicone laryngotracheal model — Target structure of the procedure.
Thyroid cartilage 1 integrated Integrated region of the 3D-printed medical-grade silicone laryngotracheal model — Superior palpable landmark of the cricothyroid membrane. A standard front-of-neck-access landmark, not separately named by Gauger 2018.
Cricoid cartilage 1 integrated Integrated region of the 3D-printed medical-grade silicone laryngotracheal model — Inferior palpable landmark of the cricothyroid membrane. A standard front-of-neck-access landmark, not separately named by Gauger 2018.
Trachea 1 integrated Integrated region of the 3D-printed medical-grade silicone laryngotracheal model — Downstream airway lumen distal to the cricothyroid-membrane access site.

Structural Parts


Part Name Qty Material Cost Notes
Laryngotracheal model housing 1 Mannequin (type/brand/model not stated by Gauger et al. 2018) — Houses the 3D-printed silicone laryngotracheal model in anatomical alignment. It is reusable.

Build Instructions

Phase 1: Fabricate the silicone laryngotracheal model

  1. Obtain a laryngotracheal anatomical dataset and prepare it as a CAD model. Gauger et al. 2018 produces the model with CAD and 3D printing, citing Kovatch et al., reference [8], for the pipeline. The paper does not specify the source anatomy or the imaging modality used. A builder will need an institutional or local equivalent to reproduce the model.
  2. Fabricate a 3D-printed laryngotracheal model from medical-grade silicone. Gauger 2018 names medical-grade silicone as the build material. The paper does not specify the exact silicone grade, durometer, printer system, slicing parameters, or the 3D-to-silicone route. A builder must select all of these locally.
  3. Inspect the fabricated silicone model. Confirm that the cricothyroid-membrane region accepts a clean 14-gauge needle puncture. The target structure must yield cleanly to the Ravussin cannula for the oxygen-insufflation step to seat correctly.

Phase 2: Seat the silicone model in the mannequin


Mannequin head used as the housing platform for the laryngotracheal model
Mannequin (illustrative). Gauger et al. (2018) describe the 3D-printed silicone laryngotracheal model as incorporated into a mannequin. Image by aorta, CC BY 2.0, via Wikimedia Commons.
  1. Seat the 3D-printed silicone laryngotracheal model within the mannequin. Gauger 2018 describes the model as incorporated into a mannequin for procedural training.
  2. Align the silicone model so that the cricothyroid-membrane region sits beneath the external skin at the anatomical midline. Learners palpate surface landmarks before needle insertion, and misalignment would invalidate the surface-anatomy training cue.
  3. Confirm the trachea of the silicone model is open distally. An inserted cannula tip must sit freely in the tracheal lumen. Oxygen delivered through the Rapid-O2 device must vent freely into the trachea.


Phase 3: External skin layer

  1. Fit an external skin layer over the laryngeal anatomy. Gauger et al. (2018), Figure 1, shows the model with its external skin removed to reveal the tracheal model. The deployed model carries an outer skin surface for landmark palpation.
  2. Note that Gauger 2018 does not specify the skin's material. The paper does not state whether the skin is printed integrally or applied as a separate covering. It also does not state how the skin is secured or what the replacement protocol is. A builder will need to define these locally for reproducibility.

Phase 4: Prepare the oxygen insufflation circuit

  1. Connect the Meditech Rapid-O2 Cricothyroidotomy Insufflation Device to an oxygen source, either wall oxygen or a portable cylinder. Gauger et al. 2018 does not specify the oxygen source. Set the device per the manufacturer's instructions. The Rapid-O2 device supplies the oxygen learners deliver after cannula placement.
  2. Prepare a single-use 14-gauge Ravussin needle/cannula. Verify that the Rapid-O2 attachment port matches the cannula hub. A mismatched connector would block oxygen delivery.

Phase 5: Learner procedure and verification

  1. Have the learner palpate the cricothyroid landmarks — the thyroid cartilage, cricothyroid membrane, and cricoid cartilage — on the model's external skin. Identifying the landmarks is the first step of the CSMP Checklist and the trainer's principal target. Gauger 2018 names only "identifies landmarks". These three are the standard front-of-neck-access landmarks, not separately enumerated by the source.
  2. Have the learner attach a saline-filled syringe to the Ravussin cannula. Have the learner stabilize the cricothyroid with the non-dominant hand. The CSMP Checklist scores both steps before the learner inserts the needle.
  3. Have the learner insert the 14-gauge Ravussin needle/cannula through the external skin and the silicone cricothyroid membrane. The needle tip enters the tracheal lumen. The learner aspirates throughout the insertion. The CSMP Checklist scores inserting through the cricothyroid membrane while aspirating.
  4. Have the learner slide the cannula off the needle into the trachea. Have the learner withdraw the needle and leave the cannula in place. These are the cannula-seating and needle-removal steps of the CSMP Checklist.
  5. Have the learner reconfirm position by aspirating air. Have the learner then stabilize/secure the cannula. The CSMP Checklist scores reconfirming position and securing the cannula before oxygenation.
  6. Attach the Meditech Rapid-O2 device. Deliver oxygen through the cannula. This completes the front-of-neck oxygenation step that the trainer rehearses.

Reset / Between learners

  1. Reset the silicone laryngotracheal model between learners. Gauger et al. 2018 does not describe a replacement or cleaning protocol. Local practice will need to define whether to reuse the silicone and whether to replace the external skin layer. It must also define how to manage prior puncture sites.
  2. If prior punctures compromise the external skin layer, it will likely need repair or replacement before the next learner. Gauger et al. 2018 describes no skin-replacement protocol.
  3. Load a fresh 14-gauge Ravussin needle/cannula for each learner because the cannula is a single-use consumable.

References

  1. ↑ Gauger VT, Rooney D, Kovatch KJ, Richey L, Powell A, Berhe H, Zopf DA. A multidisciplinary international collaborative implementing low cost, high fidelity 3D printed airway models to enhance Ethiopian anesthesia resident emergency cricothyroidotomy skills. International Journal of Pediatric Otorhinolaryngology 2018 November;114:124–128. DOI: 10.1016/j.ijporl.2018.08.040. PMID: 30262349.
    Simulator data
    Alternative names Gauger 3D-printed airway trainer; Michigan–Ethiopia cricothyroidotomy simulator
    Page data
    Keywords cricothyroidotomy, needle cricothyroidotomy, emergency airway, 3D printed airway, medical-grade silicone, Ravussin, Meditech Rapid-O2, Gauger, TissueDB
    Authors Arturopelayo
    License CC-BY-SA-4.0
    Language English (en)
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    Created April 11, 2026 by Arturo Pelayo
    Last edit September 28, 2026 by Arturo Pelayo
    Cite as Arturopelayo (2026). "TissueDB/Simulators/Cricothyroidotomy Simulator (Gauger)". Appropedia. Retrieved September 29, 2026.
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