{"id":140782,"key":"TissueDB/Simulators/Paediatric_Airway_Management_Trainer_(Carter)","title":"TissueDB/Simulators/Paediatric Airway Management Trainer (Carter)","latest":{"id":1277616,"timestamp":"2026-09-28T05:33:48Z"},"content_model":"wikitext","license":{"url":"https://www.appropedia.org/Appropedia:Copyrights","title":"CC-BY-SA-4.0"},"source":"{{TissueDB Simulator Layout\n| name = Paediatric Airway Management Trainer (Carter)\n| procedure = Paediatric airway management training: emergency front-of-neck access in can't intubate, can't oxygenate (CICO) scenarios, rigid bronchoscopic airway examination, and pathological airway planning for neonates, infants and small children\n| lead_paragraph = 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, and presented by the source 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.<ref name=\"carter2020\" /> It derives from CT imaging of a 4&nbsp;kg five-month-old infant and is printed from the trachea to the carina. The authors intended it for emergency front-of-neck access training of anaesthetic consultants and registrars across neonates, infants and small children, and for shared anaesthesia–otolaryngology airway planning from pathological airway models. In the 2020 paper, the authors proposed comparing its distensibility against animal cadaveric models. It sits within the TissueDB airway cluster alongside the [[TissueDB/Simulators/Cricothyroidotomy Simulator (Gauger)|Gauger]]<ref name=\"gauger2018\" /> and [[TissueDB/Simulators/Cricothyrotomy Simulator (Kei)|Kei]]<ref name=\"kei2019\" /> trainers, both cited in Carter 2020 (refs [3] and [6]).\n| features = Multi-property 3D print in [[TissueDB/Materials/Photopolymer Resin|Stratasys Agilus30]] photopolymer, the final-production material selected for greater tissue fidelity. The Stratasys Polyjet J750 renders full colour, variable density and flexible properties in a single object at 14-micron layers. Reproducible from the digital file and reconfigurable for age- or pathology-specific airways on request.\n| specialized_tools = Stratasys Polyjet J750 photopolymer printer (Stratasys, Rehovot, Israel). Software named by the authors: 3D Slicer (CT-to-3D-mesh), Zbrush and Meshmixer (3D-printable file), and Netfabb (mesh-error correction). For inspection by rigid bronchoscopy: Storz Hopkins 0°, 4 mm rigid telescope (Karl Storz Endoscopy Australia, Macquarie Park, NSW).\n| dev_team_contact = Jane C Carter, James Broadbent, Ella C Murphy, Bernard Guy, Katherine E Baguley and Jeremy Young — Departments of Anaesthesia and of Ear, Nose and Throat Surgery, Wellington Regional Hospital, and the Department of Industrial Design, Victoria University of Wellington, New Zealand. Corresponding author: Jeremy Young (jeremy.young@ccdhb.org.nz), who invited readers in the 2020 paper to send data files to be printed and posted.\n| version = Version 1\n| dev_status = Conception-and-development prototype; qualitative rigid-bronchoscopy demonstration only, no formal validity study (Carter et al. 2020).\n| structural_parts_rows = <tr>\n<td colspan=\"5\"><em>The Tissues table above itemises the printed anatomy.</em></td>\n</tr>\n| tissues_rows = <tr>\n<td>[[TissueDB/Tissues/Trachea|Trachea]]</td>\n<td>1 integrated</td>\n<td>[[TissueDB/Materials/Photopolymer Resin|Stratasys Agilus30]]<ref name=\"stratasys_agilus30\" /> on a Stratasys Polyjet J750 (14-micron layers)</td>\n<td>—</td>\n<td>Paediatric trachea printed from CT data of a 4&nbsp;kg five-month-old infant. The print extends to the carina, and rigid bronchoscopy shows that extent. Carter 2020 selected Agilus30 for greater tissue fidelity.</td>\n</tr>\n<tr>\n<td>[[TissueDB/Tissues/Bronchial Tissue|Bronchial tissue (carina)]]</td>\n<td>1 integrated</td>\n<td>[[TissueDB/Materials/Photopolymer Resin|Stratasys Agilus30]] on the same Stratasys Polyjet J750 print</td>\n<td>—</td>\n<td>The carina at the tracheal bifurcation, printed as part of the same single-object airway model that runs from the trachea to the carina; the carinal view was recorded on rigid bronchoscopy by a consultant otolaryngologist (Carter 2020).</td>\n</tr>\n| build_instructions = === Phase 1: Acquire and segment paediatric CT anatomy ===\n\n# 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&nbsp;kg five-month-old infant. Reproduction therefore needs institutional or local equivalent imaging.\n# Segment the airway from the CT volume in 3D Slicer. Create a 3D mesh of the trachea down to the carina.\n# Refine the mesh in Zbrush and Meshmixer to produce a 3D-printable file with appropriate wall thickness and feature continuity.\n# Run the mesh through Netfabb to detect and correct mesh errors before submission to the printer.\n\n=== Phase 2: Print on a Stratasys Polyjet J750 ===\n\n# Configure the print on a Stratasys Polyjet J750 (Stratasys, Rehovot, Israel) at 14-micron layer resolution.\n# Print the final model in [[TissueDB/Materials/Photopolymer Resin|Stratasys Agilus30]] photopolymer. Carter 2020 trialled the [[TissueDB/Materials/Photopolymer Resin|Vero]] and [[TissueDB/Materials/Photopolymer Resin|Tango]] photopolymers at varying shore hardnesses, from rigid to soft and flexible. The authors selected Agilus30 because it produced greater tissue fidelity.<ref name=\"stratasys_materials\" />\n# 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.\n\n=== Phase 3: Inspect via rigid bronchoscopy ===\n\n# 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&nbsp;mm. A consultant otolaryngologist operated it.\n# Insert the rigid bronchoscope. Confirm that the lumen is visible inside the trachea. Carter 2020 shows the expected tracheal view.\n# Advance the bronchoscope to the bifurcation. Confirm that the carina is visible. Carter 2020 shows the expected carinal view.\n\n=== Phase 4: Configure for the planned use case ===\n\n# 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.\n# The Wellington Hospital ENT department expressed interest in using the model for surgical bronchoscopic training in the 2020 paper.\n# The authors invited requests in 2020 for custom configurations (jeremy.young@ccdhb.org.nz), using data files for airway-pathology planning or age-specific CICO models. Confirm current availability before relying on this print-and-post offer.\n| references =<references><ref name=\"carter2020\">Carter JC, Broadbent J, Murphy EC, Guy B, Baguley KE, Young J. A three-dimensional (3D) printed paediatric trachea for airway management training. ''Anaesthesia and Intensive Care'' 2020;48(3):243–245. DOI: [https://doi.org/10.1177/0310057X20925827 10.1177/0310057X20925827]. PMID: [https://pubmed.ncbi.nlm.nih.gov/32536185/ 32536185].</ref><ref name=\"gauger2018\">Gauger V, Rooney D, Kovatch K, et al. 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;114:124–128. DOI: [https://doi.org/10.1016/j.ijporl.2018.08.040 10.1016/j.ijporl.2018.08.040]. PMID: [https://pubmed.ncbi.nlm.nih.gov/30262349/ 30262349]. (Carter 2020 ref [3].)</ref><ref name=\"kei2019\">Kei J, Mebust DP, Duggan LV. The real cric trainer: instructions for building an inexpensive realistic cricothyrotomy simulator with skin and tissue, bleeding, and flash of air. ''Journal of Emergency Medicine'' 2019;56(4):426–430. DOI: [https://doi.org/10.1016/j.jemermed.2018.12.023 10.1016/j.jemermed.2018.12.023]. PMID: [https://pubmed.ncbi.nlm.nih.gov/30685221/ 30685221]. (Carter 2020 ref [6].)</ref><ref name=\"stratasys_materials\">Stratasys. Materials catalogue. https://www.stratasys.com/materials/search (Stratasys photopolymer family, including the Vero and Tango lines; cited as ref [13] in Carter 2020).</ref><ref name=\"stratasys_agilus30\">Stratasys. Agilus30 photopolymer product page. https://www.stratasys.com/materials/search/agilus30 (cited as ref [14] in Carter 2020 for the final-production photopolymer).</ref>\n</references>\n| build_time_cost = Not stated in source\n| hero_image = Adult and pediatric airway anatomy (OpenCriticalCare WHO).png\n| hero_image_caption = '''Anatomical reference, not the simulator.''' The diagram compares six features of the child and adult airway: a relatively larger tongue, a floppier U-shaped epiglottis, upward-slanting vocal cords, a more anterior and superior larynx, the cricoid as the narrowest point, and a narrower, less rigid trachea. Diagram by Open Critical Care & the World Health Organization, CC BY 4.0.\n| hero_image_alt = Side-by-side labelled cutaway diagrams of a child's and an adult's head and neck, numbering six airway structures: tongue, epiglottis, vocal cords, larynx, cricoid and trachea.\n}}\n\n== Related simulators ==\n\nRelated TissueDB airway trainers: [[TissueDB/Simulators/Cricothyrotomy Simulator (Aho)|Aho]], [[TissueDB/Simulators/Cricothyrotomy Simulator (Calvo)|Calvo]], [[TissueDB/Simulators/Cricothyrotomy Simulator (D'Auria)|D'Auria]], [[TissueDB/Simulators/Cricothyrotomy Simulator (Muller)|Muller]], [[TissueDB/Simulators/Pediatric Front-of-Neck Access Simulator (Kovatch)|Kovatch]] and [[TissueDB/Simulators/Neonatal ETT Ultrasound Simulator (Qaim Ali)|Qaim Ali]].\n\n{{Page data\n| description = A 3D-printed paediatric tracheal model (Carter 2020) for neonatal, infant and small-child airway management training — emergency front-of-neck access (CICO), rigid bronchoscopy, and pathological airway planning. Printed on a Stratasys Polyjet J750 in Agilus30 photopolymer; needs an industrial printer rather than locally available materials.\n| keywords = paediatric airway, airway management training, 3D printing, trachea, front-of-neck access, CICO, rigid bronchoscopy, Stratasys Polyjet J750, Agilus30, neonatal\n}}"}