How to make realistic and cost-effective manikin models for advanced trauma procedures: emergency cricothyroidotomy, ER thoracotomy and perimortem caesarean section?

Effective trauma resuscitation occasionally requires critical lifesaving procedures which are rarely performed but flawless demanding, such as emergency cricothyroidotomy, ER thoracotomy & perimortem cesarean section. Traditional skill acquisition through real-case experience is impractical. Cost-effective, realistic and replicable models can bridge the gap in skill training. We developed inexpensive models of such to address the need to train competency and preparedness to face rare but extremely critical skill in trauma resuscitation, aiming to improve survival outcome.

Emergency cricothyroidotomy

Fig1: a reusable silicon neck model and cricothyroid-trachea complex consists of hyoid bone, thyroid cartilage in continuity with cricothyroid membrane, cricoid and trachea cartilage created by low-cost 3D printing, a condom connected to trachea, artificial skin with a red-dye filled pocket underneath. Fig4: Mist and air inside condom. Fig5 Procedures: locate cricothyroid membrane, skin incision, bleeding seen, cricothyroid membrane punctured, hissing sound heard, apply introducer to guide tracheostomy tube insertion. Mist on tubing and inflation of lung (condom) ensure correct tube placement. End-tidal CO2 as an adjunct. 

Emergency ER thoracotomy

A broken Manikin is in use Fig6. Half chest wall removed; 3D printed ribs mounted; use of low-cost silicon lung and heart Fig8. Heart in a condom filled with red-fluid (pericardiac effusion) Fig9. Towels keeps the heart in position Fig7. A yellow string on heart surface as phrenic nerve. Red foam (muscle) and red-dye pocket (blood) under artificial skin. A colored silicon drop as nipple. Fig11 Procedures: Skin incision at 5th/6th intercostal space, bleeding upon cutting subcutaneous fat & intercostal muscle, insertion of ribs spreader. Lung, heart, phrenic nerve exposed. Pericardium incised to release tamponade. Open cardiac massage & debribrillation practiced.

Peri-mortem cesarian section

Fig12: a low-cost silicon tummy model, a baby toy into a water filled condom (as liquor inside placenta), foams in different colors (yellow as subcutaneous fat, white as Linea alba, red as uterine wall). All put into the tummy pocket, mounted on manikin pre-wrapped by transparent plastic film (water protection). Fig14 Procedures: Incise skin, subcutaneous layer, Linea alba, uterine layer and placenta. Liquor leakage, grab and delivery baby, cord clamped, uterine gauze packing. Proper disposal of scalpel and dry the floor to ensure safe proceeding of CPR and debribrillation. (Videos on procedures are a/v to be presented)

These models have been used in trauma drills with very positive feedback. Participants were able to complete each skill within a short time. These tools have significantly enhanced trauma training by bridging the gap between theoretical knowledge and real-life execution. They are particularly useful to train up competency and preparedness on uncommonly-practiced but extremely critical skills in trauma resus

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