CRICOTHYROIDOTOMY TRAINER REVIEW

The DAS 2015 guidelines for the management of unanticipated difficult intubation in adults advocate scalpel cricothyroidotomy for
emergency front-of-neck access in the anaesthetised and paralysed patient where intubation and oxygenation has failed (Plan D).

Every anaesthetist should be trained to perform the Plan D technique. This document provides a summary of the features and fidelity
of simulator trainers currently available to help provide this training.

We advocate Plan D part task training in two phases: Initial technical and motor skill development with low fidelity simulators, followed by simulation to
advance non-technical and psychological skills in a stressful situation. This can be achieved using commercially available simulation apps (e.g., SimMon) in
conjuction with the trainers below.

HIGH-FIDELITY EXTREME AIRWAY TRAINER VARADAY ET AL HOMEMADE CRICOTHYROTOMY MODEL

Cost £ Incorporates home-made element Cost £ Requires assembly, from readily
Set-up manufacture and assembly. Set-up available equipment.
Fidelity+ Excellent haptic feedback from the Fidelity- Would make ideal model for
CTM Palpable p ADAMgel, allows cut-down tech- CTM Palpable p
acquiring initial motor skills for
Vertical Incision p nique. Only ultrasound-compatible Vertical Incision X
Plan D technique before moving
Ultrasound p model in this list. Ultrasound X
onto higher fidelity models.
Latex X Latex X

SIMULAIDS CRICOTHYROTOMY TRAINER DELUXE No. 135 VBM CRICO-TRAINER ADELAIDE

Cost £ £ Internal tube simulates CTM but Cost £ £ Very prominent thyroid cartilage
Set-up when present has tendency to Set-up with prominent cricothyroid gap.
Fidelity- redirect bougie into false passage. Fidelity- Low-cost foam skin inserts.
CTM Palpable p CTM Palpable p
Very prominent cricothyroid gap.
Vertical Incision X Vertical Incision X
Lubrication required.
Ultrasound X Ultrasound X
Latex p Latex p

VBM CRICO-TRAINER FROVA LAERDAL CRICOID STICK SIMULATOR

Cost ££ Improved laryngeal cartilage Cost £ £ £ Unable to perform Plan D tech-
Set-up design, low-cost foam skin inserts Set-up nique on this model with its current
Fidelity - with very easy set-up. Fidelity - design.
CTM Palpable X CTM Palpable X
Vertical Incision X Vertical Incision X
Ultrasound X Ultrasound X
Latex p Latex p

© Dr Bhavesh Patel, Dr Toby Winterbottom & Dr Wendy KIng 2017

 PHARMABOTICS CRICOTRACHEOTOMY TRAINER eNASCO LIFE/FORM CRICOTHYROTOMY SIMULATOR
Cost £ £ £ Convincing differentiation of Cost £ £ £ £ Only the ‘Open’ style laryngeal
Set-up ‘cartilaginous’ structures and Set-up insert permits Plan D technique.
Fidelity + CTM. Lubrication required (not Fidelity+ Internal clear tube simulates
CTM Palpable p supplied). CTM Palpable p CTM, but when present has
Vertical Incision X Vertical Incision X tendency to redirect bougie
Ultrasound X Ultrasound X
into false passage. Lubrication
Latex TBC Latex X
required (supplied).

SMITHS MEDICAL TRACHEOSTOMY HEAD TRUCORP AIRSIM TRUCRIC

Cost ££££ Rigid thyroid cartilage. Lubrica- Cost £ £ £ £ Lower fidelity than alternative
Set-up tion required (not supplied). Set-up TruCorp product. Laryngeal
Fidelity + Fidelity+ inserts provide realistic CTM
CTM Palpable X CTM Palpable p haptic feedback.
Vertical Incision X Vertical Incision X
Ultrasound X Ultrasound X
Latex p Latex p

VBM CRICO-TRAINER PIG LAERDAL DELUXE DIFFICULT AIRWAY TRAINER

Cost £ £ £ £ Requires separate supply of Cost £ £ £ £ £ Optional CTM tape available
Set-up porcine larynx, with ensuing Set-up TBC to simulate fibrous membrane
Fidelity + refrigerated storage and Fidelity+ for puncture. Allows combined
CTM Palpable p hygiene issues. CTM Palpable p airway management and Plan D
Vertical Incision X Vertical Incision X simulation..
Ultrasound X Ultrasound X
Latex p Latex p

SYNDAVER ADULT CRIC TRAINER TRUCORP AIRSIM ADVANCE COMBO

Cost £ £ £ £ £ Not tested directly; requires Cost £ £ £ £ £ Floating larynx provides addi-
Set-up TBC shipping direct from supplier in Set-up tional realism. Allows combined
Fidelity + United States. ‘Low-cost Adult Fidelity+ advanced airway management
CTM Palpable p Cric Trainer’ no longer available CTM Palpable p and Plan D simulation. Lubrica-
Vertical Incision p from this manufacturer. Vertical Incision X tion required (supplied).
Ultrasound X Ultrasound X
Latex X Latex p

KEY
Cost: £
£0 - £249 £ £ £250 - £499 £ £ £ £500 - £749 £ £ £ £ £750 - £999 £ £ £ £ £ > £1000
Set-up: INVOLVED STRAIGHTFORWARD VERY EASY
-
LOW: skin, thyroid cartilage, cricoid cartilage, hollow trachea
Fidelity:
+ HIGH: as above incorporating: skin texture, subcutaneous layers, fibrous CTM, tracheal rings, mandible, face, tracheal path
CTM Palpable / Vertical Incision / Ultrasound / Latex: p YES X NO © Dr Bhavesh Patel, Dr Toby Winterbottom & Dr Wendy KIng 2017