Assessment of a Low Cost Cricothyrotomy Model for Simulation and Education
Authors: Van Dillen Christine , Dicesare Danielle , Fitzpatrick Desmond , Zuver Christian , Duan Peter , Schiffert Stephanie , Rowe Joel 
Published: February 2025

Objectives

Emergent Cricothyrotomy is a life-saving procedure that should only be used as a last resort to obtain a means for oxygenation and ventilation in a critical patient when all other options have been exhausted. This study seeks to address the resource and time inefficiencies of conventional simulation techniques by assessing noninferiority of one example of a novel, cost-effective cricothyroidotomy simulation technique that uses an open-sourced, 3D printed trachea model for simulated practice among resident physicians, paramedics, and critical care flight nurses compared to the current training techniques using conventional simulation models.

Methods

Participants were randomized into two groups, a group utilizing the 3D printed model and a group using the traditional mannequin simulator. Both groups underwent a standardized educational session consisting of a PowerPoint presentation on the cricothyrotomy procedure. The initial training session consisted of an explanation of a bougie-assisted cricothyrotomy using a scalpel and endotracheal tube. The components of the educational session were consistent with a standardized, validated procedure checklist for an emergent cricothyrotomy. Participants were then randomized during the hands-on component to either the 3D-printed model or the traditional mannequin simulator. A washout period of a minimum of two weeks (but no more than three weeks) followed the initial training. After the washout period, participants were asked to perform a bougie-assisted cricothyrotomy using a scalpel and endotracheal tube on the traditional mannequin to assess the efficacy of the training.

Results

A total of 47 participants, including 14 residents, 23 critical care flight nurses and paramedics, and 10 fire-based paramedics, participated in the study. 25 (53%) participants were randomized to the 3D-printed model, and 22 (47%) participants used the standard mannequin model. Pre-training, participants in the 3D-printed model ranked their comfortability with performing a cricothyrotomy 2.7/5, whereas post-training reported 3.9/5 (P <0.05). Participants who trained with the mannequin ranked their comfortability 2.8/5 before training and 3.9/5 after training (P<0.05). After the washout period, all participants (100%) were able to complete all steps of a successful cricothyrotomy. The average time from the start of the procedure to first bag-valve mask was 63 seconds, 57 seconds for those who trained using the 3D model, and 71 seconds for those who trained using the mannequin (P<0.05). Participants rated the realistic experience of the 3D printed model 4.1/5, compared to the mannequin 3.8/5 (P=0.13). Participants agreed with the statement that the cricothyrotomy simulator used was more realistic than other models used in the past 3.7/5 in the 3D printed model group and 3.1/5 in the mannequin model.

Conclusion

This study demonstrates that the use of a low-cost, 3D-printed cricothyrotomy model is a viable and non-inferior alternative to traditional high-fidelity mannequins for training medical professionals in this high-acuity, low-opportunity procedure. While there are limitations related to the lack of anatomical context and the potential bias introduced by familiarity with the mannequin model, the results highlight the potential for 3D-printed models to provide a cost-effective and accessible means for improving cricothyrotomy training.