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CICO Rescue Cricothyroidotomy Trainer - Vortex Approach

by drandybuck, published

CICO Rescue Cricothyroidotomy Trainer - Vortex Approach by drandybuck Sep 12, 2017

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Summary

This is the first free, open access, fully functional, 3D-printable neck/larynx combination cricothyroidotomy trainer.

This version 1.0, updates will be made based on your feedback.

These models were created by Dr Andy Buck and are distributed under a Creative Commons license as a free educational model to teach the procedure of cricothyroidotomy, a life saving medical procedure performed in a "Can't Intubate Can't Oxygenate" (CICO) Rescue situation.

These models have been designed to supplement the Vortex Approach to Airway Management and CICO Rescue teaching material available at http://vortexapproach.org/

This is a 2 part model:

1) Larynx - this is best printed with a flexible filament such as Polyflex or Ninjaflex. It is an anatomically correct adult larynx piece that fits into the neck model, but can also be used as a standalone bench-top cric trainer.

2) Neck - this is best printed in PLA or ABS. This is a CAD generated anatomical representation of an adult neck, with a chin, sternum and tracheal parts that mimic real anatomy.

Each part can also be easily re-sized using software such as Simplify3D to create paediatric versions of any size.

To use the trainer, place the larynx into the neck, then place a piece of medical tape such as sleek over the cricothyroid space (to act as a cricothyroid membrane), then slide a sheet of 3-5mm foam (to act as skin - EVA/closed cell foam works best), 10cm in width, through the vertical slots on the neck model to cover the larynx, pull it down taut so that it comes out of the elevated gap on each side, then place the neck on a flat surface. This will hold the skin snugly in place during the procedure. This way each learner can take a turn performing a cricothyroidotomy, then simply lift the skin, replace the cricothyroid membrane tape, slide the skin along a few centimetres and pull it back down for the next learner.

Extra thicker foam can be added under the thin foam skin to mimic subcutaneous fat or swelling. The model is also water-proof and washable (in tap water - not dishwasher!) so other simulation props such as fake blood can also be used (for example, by placing a fluid-containing zip-lock bag with fake blood between two foam layers).

Double sided tape or velcro can be used to hold the neck on a table or board for stability.

We would like to acknowledge the University of Dundee, BodyParts3D and The Database Center for Life Science as the original source of the larynx file which has been modified for this project.

The original source file for the larynx model is available here:
https://sketchfab.com/models/a00bc73a303c46248db6a13a88b23404

If you make either of these, please upload a photo using the "I made one" link above, we'd love to see how they turn out.

Print Settings


Notes:

Print larynx using flexible filament such as Ninjaflex or Polyflex.
Depending on your printer settings, it can take 2-3 hours to print the larynx.

Print neck using PLA or ABS.
As it is a large model, it can take 12-14 hours to print on a standard desktop 3D-printer.

How I Designed This

Design process

These models took hundreds of hours of work to design, prototype, print, refine, test, re-model and update, with this cycle repeated many times for each part.

The larynx was modified from the original version using programs such as Blender and Meshmixer.

The neck model was created using Autodesk Fusion 360.

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Hi, thanks for sharing. I've been asked to print this, and it appears to my (non-clinical) eye that printing could be made easier without affecting the functionality.

The big issue is the size, especially of the neck at 161x220x118mm. I do accept that that is the real size of a real neck, but there's not many printers that can manage that. For my printer (180 diam x 300 high Delta), I'll need to stand the neck on its end. The first issue with that is that the ends of the neck part are curved. It would be much easier if one or other end was flat, with no overhangs, to provide a solid base. The second issue is that in the vertical orientation, there are overhangs at the ends of the various slots. If the slots were continued through the top of the piece, there would be no overhang. Alternatively, if the slopes at the opposite end of the slots to the flat were 45-60deg relative to the flat, the overhang could be managed by most printers, so it could be printed without generated support.

Alternatively, I guess I could cut the neck in half, perhaps about 75mm from the bottom and/or about 30mm from the top, at the point of the chin. Would you mind sharing the CAD source files for the neck?

Similarly, I think that printing the larynx in a horizontal orientation would result in lots of support being required inside it, and that these supports would be difficult to remove without damaging the part. It seems to me that the larynx would be easier to print in the vertical orientation, with the top squared off about 10mm down and a solid baseplate added. Support would then only needed in a couple of places. These supports could be generated by (e.g.) Meshmixer, and included in the STL so that the end-user wouldn't need to generate them in his slicer.

Hi FlightMedic. I've attached some screenshots of the settings I used to print the larynx component with Polyflex which is a good flexible filament. (I use Simplify3D as my printing program). This took a long time to get right and may need to be adjusted for different printers/batches of filament. The main thing I've found with flexible filament is to really slow down the print speed (I'm using 600mm/min, or 10mm/sec, which is very slow, but I get fairly good quality prints). The neck component can be printed with PLA or ABS at a much higher print speed (I've used 0.2mm layer height with PLA). As the neck is a much larger piece, if you use too much infill it takes forever to print. I think I used about 15% infill for the neck (and it took about 14 hours), but 20-25% will make it more sturdy. Hope that helps and be sure to upload some pictures into the "I made one" section!

I am planning to print this and compare it to some other 3D cric trainers. Can you tell me what settings you used? Specifically layer height and infill?

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