The next two weeks are going to be very difficult, and the risk of ventilator shortages due to COVID-19 is high. Manufacturing will ultimately help, but it takes time.
I’m already aware of one hospital in New York that can no longer provision one “vent” per patient, and demand is likely to grow dramatically over the next 7–10 days as cases spike. Even with full lockdown and total compliance, one could expect admittance to grow for 10–12 days minimum, based on the data we have from other countries.
In emergency circumstances, the below modification can be completed in less than 10 minutes and enables one ventilator to intubate as many as four people (instead of one). I first learned of it from Victor Cheng earlier this week, and Dr. Charlene Babcock demonstrates it below:
This has been performed successfully in animals, such as on four human-sized (70kg) sheep (Increasing Ventilator Surge Capacity in Disasters: Ventilation of Four Adult-Human-Sized Sheep on a Single Ventilator With a Modified Circuit), and Dr. Charlene Babcock from the above video has also completed proof of concept studies with colleagues. The following text is from Victor Cheng’s blog post:
In 2006, Dr. Greg Neyman and Dr. Charlene Babcock, Emergency Medicine physicians in Detroit, Michigan, did a study on exactly this. They wondered if, during a disaster-related surge of patients, a ventilator could be reconfigured to support multiple patients. Would it work? Short answer: Yes. They used standard equipment found in an emergency room to create a two-way and four-way splitter. They then used the ventilator to ventilate four simulated-lung devices for 12 hours. These devices had several sensors to track the output of the ventilator for each “lung.” The data collected showed that the pilot project was successful.
ANOTHER POSSIBLE OPTION:
A separate friend in healthcare (Thanks, Franz!) linked me to the Philips Respironics bi-level ventilator BiPAP A40 and noted the following, which I’ve slightly edited for format:
[Hospitals] should consider using small CPAP devices with modes designed to deliver timed breaths. They look like small NIV or CPAP devices and are commonly used with a mask interface. But it may not be common knowledge that these devices are also approved for invasive ventilation and that they have pressure control modes with timed breaths.
In the above option, I realize that monitoring would be sub-optimal and that there are other complications to consider, but some oxygen may be better than no oxygen.
I am publishing this post with the full understanding that:
- Some hospitals are already considering these types of contingencies and preparing for worst-case scenarios. That said, many are not, hence this post.
- These solutions aren’t optimal, but they are likely better than choosing who lives and who dies, as we’ve seen happen in Italy. In the case of Dr. Babcock’s demonstrated modification, if doctors can match up size and lung compliance, and provided patients can all be on the same settings and you’re willing to accept cross-contamination on a single machine, this could very well save lives.
If you agree, thank you for sharing this piece.
And if you’re looking for some inspirational reading, I highly suggest “Not All Heroes Wear Capes: How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History.”