Apparatus and method for a cannulation, chest compression, and ultrasound compatible ECMO manikin

Abstract

Provided herein is an apparatus and method for ultrasound compatible ECMO training of medical professionals, specifically to train them in performing cannulation in real surgical scenarios. The apparatus can include a manikin for Extracorporeal Membrane Oxygenation (ECMO) training including: a body of the manikin formed to resemble at least a portion of a human torso; a closed-circuit circulation loop within the body; at least one cavity within the body proximate a location corresponding to a thigh; at least one removable gel insert received within the at least one cavity; a medial chest plate including one or more springs attached to a top side of the medial chest plate; and a top chest plate attached to the one or more springs opposite the medial chest plate, where a compartment is defined below the medial chest plate, and wherein the closed-circuit circulation loop is disposed at least partially within the cavity.

Description

APPARATUS AND METHOD FOR A CANNULATION, CHEST COMPRESSION, ANDULTRASOUND COMPATIBLE ECMO MANIKINFIELD

[0001] Provided herein is an apparatus and method for Extracorporeal Membrane Oxygenation (ECMO) training, and more particularly, for an apparatus and method for ECMO training that provides cannulation and chest compression capabilities, as well as ultrasound compatibilities.BACKGROUND

[0002] Extracorporeal Membrane Oxygenation (ECMO) is an advanced therapy for the heart and lungs that requires significant medical training and practice to master. Treatment involves the use of a machine to re-oxygenate blood, remove carbon dioxide from the blood, and pump the blood back into the body. This requires catheterization of an artery to tap into the bloodstream.

[0003] Extracorporeal cardiopulmonary resuscitation (ECPR) is another practice used to medically treat patients undergoing cardiac arrest. ECPR is often considered superior to conventional CPR, especially for in-hospital cardiac arrests. In many cases, ECMO is used as an adjunct to CPR or ECPR. Educating medical providers in techniques of ECMO, ECPR, and CPR is challenging.BRIEF SUMMARY

[0004] Embodiments of the present disclosure generally relate to an apparatus and method for cannulation, chest compression, and ultrasound compatible training of medical professionals in more realistic medical scenarios than current technology can provide. Embodiments provided herein include a manikin for Extracorporeal Membrane Oxygenation (ECMO) training including: a body of the manikin formed to resemble at least a portion of a human torso; a closed-circuit circulation loop within the body; at least one cavity within the body proximate a location corresponding to a thigh; at least one removable gel insert received within the at least one cavity; a medial chest plate including one or more springs attached to a top side of the medial chestpl ate; and a top chest plate attached to the one or more springs opposite the medial chest plate, where a compartment is defined below the medial chest plate, and wherein the closed-circuit circulation loop is disposed at least partially within the cavity.

[0005] According to some embodiments the closed-circuit circulation loop includes tubing of a first material and tubing of a second material, where the first material is different from the second material. According to some embodiments the first material is latex, and the second material is silicon. According to some embodiments the at least one removable gel insert is formed of a material permeable by an ultrasonic sensor.

[0006] According to certain embodiments the one or more springs attached between the medial chest plate and the top chest plate includes four springs. According to some embodiments each of the four springs includes a spring rate of about 20 pounds per inch. The at least one removable gel insert includes in some embodiments at least one tube molded within the at least one removable gel insert. According to certain embodiments the at least one tube molded within the at least one removable gel insert is connected with the closed-circuit circulation loop. The at least one tube molded within the at least one removable insert is in some embodiments connected with the closed-circuit circulation loop with couplings, where the at least one removable gel insert is replaceable.

[0007] Embodiments described herein include a method for a replaceable gel insert for a manikin including receiving, through a mold cavity, at least one tube section; receiving into the mold cavity, a liquid gel; curing the liquid gel to solidify into a gel insert; and demolding the gel insert from the mold. At least one tube section of an embodiment includes a first tube section and a second tube section. According to some embodiments, receiving, through the mold cavity, the first tube section and the second tube section includes receiving the first tube section and the second tube section across the mold cavity, where the first tube section and the second tube section extend outside of the mold. The first tube section and the second tube section of some embodiments include fittings on opposing ends of a respective tube section. The method of some embodiments includes receiving the gel insert into a cavity of a manikin. The method of certain embodiments includes connecting the first tube section and the second tube section to a closed- circuit circulation system.

[0008] Embodiments provided herein include a manikin with a body, a closed-circuit circulation loop, at least one thigh cavity, at least one removable gel insert, a medial chest plate, a top chest plate, one or more springs, and a cavity below the medial chest plate. These features work together to produce a training apparatus that allows medical professionals to practice real surgical scenarios related to cannulation and chest compressions. Further, some embodiments include ultrasound compatibilities so that medical professionals can further analyze and study cannulation techniques by visualizing them more effectively.

[0009] According to some embodiments, the manikin body is similar to a conventional CPR manikin in shape, size, and material. In some embodiments, it is necessary to manufacture portions of the manikin body to support the detailed features. For instance, embodiments disclosed herein detail a manikin in which the pelvic region is manufactured separately from the rest of the manikin body to accommodate for the gel insert cavities. The means of manufacture of the manikin body is not limited and could be accomplished by many methods, using many different materials. It is desirable for the manikin body to appear similar to a real human body to produce realistic medical scenarios. Therefore, some embodiments could include more realistic skin texture, realistic skin colors, and other similar modifications.

[0010] According to some embodiments, the closed-circuit circulation loop is constructed using tubing of differing diameters and differing materials to best simulate a human circulation system. In some embodiments, the portion of the closed-circuit circulation loop that mimics a femoral vein is made using latex, and the portion of the closed-circuit circulation loop that mimics a femoral artery is made using silicon. In some embodiments, the rest of the tubing is also made using silicon. Quick disconnect tubing connectors are present in some embodiments to allow for easy tubing replacement. Pressure bags are also used in some embodiments to maintain a specified flow rate within the closed-circuit circulation loop. It is beneficial that this closed- circuit circulation loop is non-kinking and maintains its specified flow rate consistently. In some embodiments, the tubing length is specified to mimic the venous, arterial, and distal reperfusion cannulas present in the human body.

[0011] According to some embodiments, the closed-circuit circulation loop is disposed at least partially within the cavity below the medial plate. This cavity is designed to protect theportion of the closed-circuit circulation loop that is disposed within the cavity from the forces of any form of chest compressions.

[0012] According to some embodiments, each of the gel inserts is molded specifically to fit the thigh cavities of the manikin. Gel insert molds are used in some embodiments to facilitate the casting of the gel. According to some embodiments, a material such as gelatin or Humimic™ gel is cured using the gel insert molds. The gel inserts are replaceable to ensure that the practicing medical professional can perform cannulation many times with the same manikin. While the gel inserts are well-suited for ultrasound in-situ within the manikin cavities, the gel inserts can be analyzed after removal to confirm cannulation locations / positions from other angles once removed for analysis of the procedure performed. In some embodiments, the method of performing cannulation using this manikin includes molding the gel, inserting the gel inserts into the thigh cavities of the manikin, performing cannulation, removing the gel inserts from the thighs of the manikin, and optionally performing an ultrasound on the removed gel inserts. The method for casting these gel inserts is described in greater detail herein.

[0013] According to some embodiments, each of the gel inserts comprises at least one tube molded within the gel insert. The at least one tube is used to mimic a human vein and / or a human artery. According to some embodiments, the at least one tube within the gel insert is connected with the closed-circuit circulation loop of the manikin. According to some embodiments, couplings are used to connect the at least one tube within the gel insert with the closed-circuit circulation loop. This layout allows the at least one replaceable gel insert to contain at least one tube within itself that mimics a human vein and / or a human artery and that is connected to the closed-circuit circulation system, creating a realistic medical scenario for medical professionals to practice within.

[0014] According to some embodiments, a chest compression system including the top plate, the medial plate, and the one or more springs is designed to withstand at least a certain amount of force from an external chest compression simulation device. The top plate comes into direct contact with the external chest compression simulation device. The one or more springs are attached between the top plate and the medial plate. The medial plate is affixed a certaindistance above the bottom of the manikin’s chest cavity to provide a protected compartment for at least a portion of the closed-circuit circulation loop.

[0015] According to some embodiments, the top plate is curved to mimic the shape of a human chest. This top plate could be manufactured using many different methods and using many different materials. It is beneficial for the material used to be thin and strong to best support the force generated by the chest compression simulation device. In some embodiments, the top plate is manufactured using a 0.5-inch polyethylene sheet. It is important to note that other materials could be used and may be more beneficial to the strength and durability of the top plate. For instance, polycarbonate could instead be used as it has a high impact force.

[0016] According to some embodiments, the medial plate is flat and affixed a certain distance above the bottom of the manikin’s chest cavity. In some embodiments, the medial plate is manufactured in a similar way to the top plate using similar materials. However, the medial plate could be created using alternate manufacture methods or alternate materials, similarly to the top plate. There are many methods for affixing the medial plate above the bottom of the manikin’s chest cavity. In some embodiments, wooden dowels are utilized to support the medial plate. According to some embodiments, it is important that the means of supporting the medial plate leave space for at least a portion of the closed-circuit circulation loop.

[0017] According to some embodiments, the one or more springs comprises four springs, each with a spring rate of about 20 pounds per inch. The number of springs and the spring rate of each spring is not limited and can vary through different embodiments. The springs are used to mimic the resistance of a human chest and withstand the forces of the external chest compression simulation device.

[0018] Embodiments provided herein include a method for a replaceable gel insert for a manikin comprising receiving, through a mold cavity, at least one tube section; receiving into the mold cavity, a liquid gel; curing the liquid gel to solidify into a gel insert; and demolding the gel insert from the mold. According to some embodiments, the at least one tube section comprises two tube sections, a first tube section and a second tube section. These tube sections can correspond to a human vein and a human artery that they mimic. In some embodiments, these tube sections mimic a femoral vein and a femoral artery in a human thigh.

[0019] According to some embodiments, the liquid gel comprises a gelatin or a Humimic™ gel. In some embodiments, this gel is ultrasound compatible such that a medical professional could analyze the tube sections or visualize a cannulation procedure. This gel is poured into the mold cavity and cured until it has solidified and become the gel insert. This gel insert is demolded from the mold cavity to be used in a cannulation procedure.

[0020] According to some embodiments, the tube sections extend outside of the mold with fittings attached to each of the ends of the tube sections. According to some embodiments, the gel insert is placed within a cavity of a manikin and the tube sections are connected to a closed- circuit circulation system.BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Having thus described the invention in general terms, reference will now be made to the accompanying drawings, which are not necessarily drawn to scale, and wherein:

[0022] Figure 1 illustrates a diagram of an Extracorporeal Membrane Oxygenation (ECMO) manikin according to an example embodiment of the present disclosure;

[0023] Figure 2 is an image of the pelvic region of an ECMO manikin according to an example embodiment of the present disclosure;

[0024] Figure 3 illustrates the pelvic region of an ECMO manikin with gel inserts in place according to an example embodiment of the present disclosure;

[0025] Figure 4 illustrates a left side of the pelvic region of an ECMO manikin without gel inserts in place according to an example embodiment of the present disclosure;

[0026] Figure 5 illustrates a right-side gel insert mold according to an example embodiment of the present disclosure;

[0027] Figure 6 is an image of a gel insert removed from an ECMO manikin according to an example embodiment of the present disclosure;

[0028] Figure 7 illustrates a diagram of a closed-circuit circulation loop according to an example embodiment of the present disclosure;

[0029] Figure 8 illustrates a diagram of the side view of a chest compression system according to an example embodiment of the present disclosure;

[0030] Figure 9 illustrates multiple isometric views of a chest compression system according to an example embodiment of the present disclosure; and

[0031] Figure 10 is an image of a chest compression system installed in an ECMO manikin according to an example embodiment of the present disclosure.DETAILED DESCRIPTION OF THE DRAWINGS

[0032] Example embodiments of the present disclosure will now be described more fully hereinafter with reference to the accompanying drawings, in which some, but not all embodiments of the invention are shown. Indeed, the invention may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Like numbers refer to like elements throughout.

[0033] Embodiments of the present disclosure generally relate to an apparatus and method for ultrasound compatible Extracorporeal Membrane Oxygenation (ECMO) training of medical professionals. Embodiments described herein can be employed to train medical professionals for performing cannulation in real surgical scenarios using a manikin that simulates a human patient. The apparatus of an example embodiment includes a manikin that includes a closed-circuit circulation loop; removable gel inserts in the thighs of the manikin for performing cannulation; and a series of chest plates that withstand forces from Extracorporeal Cardiopulmonary Resuscitation (ECPR) compressions and protect portions of the closed-circuit circulation loop. Conventional methods of ECMO training do not include the chest compression system nor the ability to perform ultrasounds on a manikin. Current techniques of practicing cannulation on ECMO manikins do not include the added realism of ECPR chest compressions occurring simultaneously. There are presently no effective devices that encapsulate all these real-world medical scenarios into one training apparatus. Embodiments described herein provide a system that includes cannulation capabilities, chest compression system capabilities, and ultrasound compatibility.

[0034] Embodiments of the apparatus for ECMO training could be used by medical professionals or medical professionals in training to practice cannulation in a real-world scenario through simulation of various aspects of human anatomy with a single manikin. Embodiments could be used in medical universities or any other location where medical training takes place.

[0035] The removable gel inserts used to simulate human tissue for purposes of both cannulation and ultrasound imaging can be replaceable as they are a wear component of the manikin, while the body of the manikin can be formed of a more robust material that permits significant use without degradation. The removable gel inserts are formed using a mold cavity that has the same shape and size as a corresponding cavity on the body of the manikin. The mold of an example embodiment includes passages through which tubing can be inserted before the mold is filled to mold into the insert the tubing that simulates the artery and vein. Once the tubing is secured in place, a material, such as a gelatin or Humimic™ gel can be poured into the mold and cured. Once the gel is cured, the gel insert can be demolded. The gel insert can be fitted into a corresponding cavity of the body of the manikin, and the tubing connected to the closed-loop fluid system of the manikin that simulates blood flow in a human body. The manikin is then ready to be used for training purposes.

[0036] According to an example use, a medical professional is able to practice cannulation on cannulation sites in the manikin. The replaceable gel inserts, which are received into corresponding cavities of the manikin can be received, for example, in cavities proximate an upper thigh location of the body of the manikin to simulate cannulation sites in thighs. Once the replaceable gel inserts are inserted within the corresponding cavity, the tubing can be connected to the closed-loop circulation system of the manikin, and the circulation initiated. The ECPR compressions can also be started, such as using a Lund University Cardiopulmonary Assist System (LUCAS) device. The medical professional can then perform cannulation in the same way that it would be performed on a human patient.

[0037] Once the procedure or training is completed, an operator (e.g., the medical professional, an instructor, etc.) can shut down the circulation flow loop system and the chest compression system and then remove the gel inserts if they have reached the end of their serviceable life. The replaceable gel inserts are ultrasound compatible, such that an ultrasoundcan be performed during cannulation and / or for post-procedure analysis of the cannulation. This can permit a user to better analyze and understand the structure of the femoral vein and femoral artery. The apparatus is designed such that a medical professional could repeat these procedures many times as needed until properly trained or comfortable with the procedure.

[0038] Figure 1 illustrates elements of an example embodiment of an ECMO manikin 100 with chest compression capabilities and cannulation capabilities. As shown, a chest compression system 104 and gel insert cavities 103 are defined within a human-like manikin body 105. In this embodiment, the chest compression system 104 can be a removable section of the manikin body 105 that is found in the chest region of the manikin body 105. In this embodiment, the gel insert cavities 103 are found in the upper thigh region of the manikin body 105. In some embodiments, this manikin body 105 is similar to conventional CPR manikins in shape and size; however, the manikin of example embodiments described herein includes the torso through the upper thigh region. The manikin body 105 also houses a closed-circuit circulation flow loop that mimics both the femoral vein with femoral vein tubing 101 and the femoral artery with femoral artery tubing 102. In this embodiment, the chest compression system 104 is supported above a cavity within the manikin body 105, where the cavity is used to protect and house at least a portion of the closed-circuit flow loop. In some embodiments, ultrasound-compatible gel inserts would be inserted into the cavities 103 for gel inserts, allowing for cannulation training.

[0039] Figure 2 depicts the full pelvic region 106 of an ECMO manikin body 105 according to an example embodiment of the present disclosure. As shown, the full pelvic region 106 of this embodiment is formed to accommodate for the gel insert cavities 103. The manikin body 105 can be formed of a plastic or composite material, and can be made in a variety of ways, such as by 3D printing, molding, etc. As shown, the outermost tubing mimics the femoral vein and can be made of latex in this embodiment. In the human body, the femoral vein is collapsible under pressure, while the femoral artery is not. Accordingly, according to some embodiments described herein the tubing for the femoral vein tubing 101 is formed of a different material than the rest of the tubing. The tubing for the femoral artery tubing 102, as well as the rest of the tubing within the closed-circuit circulation loop, can be made of silicon, for example. The difference inmaterials allows medical professionals to practice feeling for a difference between the femoral vein and femoral artery when performing cannulation in a real-world scenario.

[0040] Figure 3 illustrates the pelvic region 106 of an ECMO manikin body 105 with gel inserts 107 in place according to an example embodiment of the present disclosure. As shown, the cavities 103 for gel inserts have been filled in with the gel inserts 107. The gel inserts in this embodiment are rectangular in shape from a top view but are designed to match the contour of the thighs of the manikin. The gel inserts 107 are modeled to easily slide in and out of the gel insert cavities 103 for easy replacement. Optionally, the cavity or the insert may be lubricated to enable a tight fitting insert to be more readily received within the cavity. This allows medical professionals to quickly and simply repeat cannulation procedures without wasting excessive amounts of time cleaning or setting up another ECMO manikin body 105.

[0041] Figure 4 illustrates the left side of the pelvic region 106 of an ECMO manikin without gel inserts 107 in place according to an example embodiment of the present disclosure. As shown, the gel insert cavities 103 of the illustrated embodiment have a flat bottom and flat sides where the gel inserts 107 slide into. This creates a surface with minimal friction so that the gel inserts 107 are able to slide into and out of the gel insert cavities 103 with minimal difficulty. While the illustrated embodiment includes rectangular cavities with flat bottoms, the cavities can include any shape, and the bottom can also have a variety of profiles. Further, the cavities may be keyed or shaped to ensure the inserts only fit in the proper orientation to preclude erroneous insertion. The requirement for the cavities is that the mold cavity for forming the gel inserts matches the size and shape of the cavities.

[0042] Figure 5 illustrates a gel insert mold according to an example embodiment of the present disclosure. In some embodiments, this mold could be, for example, manufactured by 3D printing using PLA filament; however, any other reasonable means of manufacture could be used to create these gel insert molds. It is important to note that a right-side gel insert mold is shown and that an equivalent left-side gel insert mold exists that is mirrored to fit the opposite thigh of the manikin body 105. The size of this mold should correspond to the size of the gel insert cavities 103. As shown, the mold includes outer walls 200, holes for the femoral vein opening 202, tubing openings for the femoral artery opening 201, and a bottom 203 contoured to matchthe shape of the manikin’s thigh. According to an example of its use, a user preparing the replaceable gel inserts would perform the following steps: place the precut tubing for the femoral vein in its opening 202; place the precut tubing in the femoral artery opening 201; melt Humimic™ gel or prepare gelatin and pour the gel into the mold until it reaches the top of the mold’s outer walls 200 or a fill line demarked by the mold; let the gel set; remove the gel insert 107 from the mold; optionally perform an ultrasound on the mold for confirmation of tubing placement and insert quality; place the gel insert 107 within its appropriate gel insert cavity 103; connect the femoral vein tubing 101 to the closed-circuit circulation loop; and connect the femoral artery tubing 102 to the closed-circuit circulation loop. After following these steps, the manikin is prepared for a practice cannulation upon the manikin 100.

[0043] Figure 6 is an image of a demolded gel insert 107 for use with an ECMO manikin 100 according to an example embodiment of the present disclosure. As shown, the gel insert 107 includes a set Humimic™ gel 300, tubing for a femoral vein tubing 101, and tubing for a femoral artery tubing 102. In this embodiment, the gel insert 107 is formed of ultrasound compatible gel, allowing medical professionals to analyze the differences between the femoral vein and the femoral artery and to guide a cannulation. Also, the gel was used in this embodiment to allow medical professionals to physically feel for the femoral vein and the femoral artery, paralleling real -world scenarios. As shown, the tubing protrudes from the ends of the hardened gel 300, making it easy and convenient to attach to and detach from the closed-circuit circulation loop system. In some embodiments, these gel inserts 107 can be re-molded between training simulations and reused in an effort to save materials and reduce expenses.

[0044] Figure 7 illustrates a diagram of a closed-circuit circulation loop according to an example embodiment of the present disclosure. As shown, the closed-circuit circulation loop comprises pressure bags 401 to maintain a specified circulation rate, an upper tubing section 402, femoral vein tubing 101 sections, femoral artery tubing 102 sections, lower leg tubing 403 sections, and a pelvic tubing 404 section. In some embodiments, the dimensions of the tubing lengths and diameters is specific such that the tubing is anatomically accurate.

[0045] According to some embodiments, these lengths and diameters are as follows: the distance from the femoral vein tubing 101 to the top of the upper tubing 402 section measures 85centimeters; the vertical length of the femoral vein tubing 101 is 8 inches; the vertical length of the femoral artery is 8 inches; the horizontal length of the lower leg tubing section 403 is 10 centimeters; the horizontal length of the pelvic tubing section 404 is 40 centimeters; the diameter of the upper tubing section 402 is 14 millimeters; the diameter of the femoral vein tubing 101 is 12 millimeters; the diameter of the femoral artery tubing is 12 millimeters; the diameter of the lower leg tubing 403 is 8 millimeters; and the diameter of the pelvic tubing 404 is 8 millimeters. These dimensions are merely an example embodiment and not limiting of the ECMO manikin described herein.

[0046] According to some embodiments, the pressure bags 401 are used to maintain a consistent flow rate of around 5 liters per minute while the apparatus is in use. Also, in some embodiments, quick disconnect tubing connectors are used to allow for easy tubing replacement and convenient replacement of the gel inserts.

[0047] Figure 8 illustrates a diagram of the side view of a chest compression system 104 according to an example embodiment of the present disclosure. As shown, this chest compression system 104 contains a top plate 501, a plurality of springs 502, a medial plate 503, supports for the medial plate 504, and a compartment defined below the medial plate 505. The supports for the medial plate 504 are supported on the bottom of the manikin’s chest cavity 506. According to some embodiments, the medial plate 503 is spaced around 2.75 inches above the bottom of the manikin’s chest cavity 506. Also, the number of springs 502 present in some embodiments is four, though more or fewer springs can also be used without deviating from the scope of the disclosure. With four springs 502, according to some embodiments, the spring rate of each spring 502 is 20 pounds per inch to help simulate the resistance provided by an adult human chest. In some embodiments, the springs 502 used are Music-Wire steel 3 -inch springs, each with a spring rate of 20 pounds per inch and maximum load of 42 pounds. Such a configuration can ensure that the chest compression system can support about 100-125 pounds of force.

[0048] According to some embodiments, a Lund University Cardiopulmonary Assist System (LUCAS) device is used to simulate ECPR upon the manikin. The LUCAS device is used in medical practice to perform ECPR upon patients with better efficiency and consistencywhen compared to a human performing CPR. The chest compression system 104 described in this disclosure allows the apparatus to undergo ECPR and cannulation at the same time, allowing medical professionals to practice realistic medical scenarios.

[0049] Figure 9 illustrates multiple isometric views of a chest compression system 104 according to an example embodiment of the present disclosure. As shown in this diagram, only one spring 502 is used to support the top plate 501. This is to show the many different possible embodiments of the present disclosure. As the number of springs 502 changes, the spring rate of each spring 502 would also need to change to support the forces of the LUCAS device or any other chest compression simulation device.

[0050] Figure 10 is an image of a chest compression system 104 installed in an ECMO manikin body 105 according to an example embodiment of the present disclosure. As shown, in some embodiments the top plate 501 is curved to mimic the shape of a human chest more accurately. The top plate 501 and medial plate 503 can be made of any resilient and rigid material. This can include metal, composites, durable plastics, or the like. It is beneficial for the material used to be thin and strong to best support the force generated by the chest compression simulation device. In some embodiments, the top plate 501 and the medial plate 503 are manufactured using a 0.5-inch polyethylene sheet. It is important to note that other materials could be used and may be more beneficial to the strength and durability of the top plate 501 and / or medial plate 503. For instance, polycarbonate could instead be used as it has a high impact force.

[0051] Many modifications and other embodiments of the inventions set forth herein will come to mind to one skilled in the art to which these inventions pertain having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the inventions are not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.

Claims

CLAIMS1. A manikin for Extracorporeal Membrane Oxygenation (ECMO) training comprising: a body of the manikin formed to resemble at least a portion of a human torso; a closed-circuit circulation loop within the body; at least one cavity within the body proximate a location corresponding to a thigh; at least one removable gel insert received within the at least one cavity; a medial chest plate comprising one or more springs attached to a top side of the medial chest plate; and a top chest plate attached to the one or more springs opposite the medial chest plate, wherein a compartment is defined below the medial chest plate, and wherein the closed-circuit circulation loop is disposed at least partially within the at least one cavity.

2. The manikin of claim 1 , wherein the closed-circuit circulation loop comprises tubing of a first material and tubing of a second material, wherein the first material is different from the second material.

3. The manikin of claim 2, wherein: the first material comprises latex; and the second material comprises silicon.

4. The manikin of claim 1, wherein the at least one removable gel insert is formed of a material permeable by an ultrasonic sensor.

5. The manikin of claim 1, wherein the one or more springs attached between the medial chest plate and the top chest plate comprises four springs.

6. The manikin of claim 5, wherein each of the four springs comprises a spring rate of about 20 pounds per inch.

7. The manikin of claim 1 , wherein the at least one removable gel insert comprises at least one tube molded within the at least one removable gel insert.

8. The manikin of claim 7, wherein the at least one tube molded within the at least one removable gel insert is connected with the closed-circuit circulation loop.

9. The manikin of claim 8, wherein the at least one tube molded within the at least one removable gel insert is connected with the closed-circuit circulation loop with couplings, wherein the at least one removable gel insert is replaceable.

10. A method for a replaceable gel insert for a manikin comprising: receiving, through a mold cavity of a mold, at least one tube section; receiving into the mold cavity, a liquid gel; curing the liquid gel to solidify into a gel insert; and demolding the gel insert from the mold cavity of the mold.

11. The method of claim 10, wherein the at least one tube section comprises a first tube section and a second tube section.

12. The method of claim 11, wherein receiving, through the mold cavity, the first tube section and the second tube section comprises receiving the first tube section and the second tube section across the mold cavity, wherein the first tube section and the second tube section extend outside of the mold.

13. The method of claim 12, wherein the first tube section and the second tube section include fittings on opposing ends of a respective tube section.

14. The method of claim 13, further comprising: receiving the gel insert into a cavity of a manikin.

15. The method of claim 14, further comprising: connecting the first tube section and the second tube section to a closed-circuit circulation system.

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