As the COVID-19 pandemic continues to sweep across the globe, there have been mounting concerns for the capacity of hospitals to deal with the virus’ victims. Italy has been at the forefront of reports warning the rest of the world of the crisis the SARS-CoV-2 virus has wrought on healthcare systems. However, in these hardest-hit regions, the reported scarcity of one resource in particular has led the scientific community from around the world to come up with some emergency solutions.
Ventilators help people breathe when they cannot manage to do so on their own by delivering air into the lungs via a tube in the windpipe. COVID-19, the respiratory illness caused by the virus SARS-CoV-2, targets the lungs, and can lead to further complications such as pneumonia. In severe instances, patients will need a ventilator to support their breathing.
In Italy, where the death toll recently surpassed that of China, doctors have already been forced to choose which patients receive support from the limited supply of ventilators. In the US, the Johns Hopkins Center for Health Security warns that during a severe pandemic the demand for ventilators “could quickly overwhelm” the nation’s stockpile of around 160,000.
Detroit-based Dr Charlene Babcock recently took to YouTube to share her knowledge of a “risky” ventilator hack that quickly modifies one ventilator to ventilate more than one patient. Based on a pilot study of the technique published in Academic Emergency Medicine in 2006, Babcock describes how you can use readily available emergency department equipment to “hack” a single ventilator unit (meant just for one patient) to help treat four patients simultaneously.
Babcock, was quick to point out the many limitations of the procedure, and urged caution to those who may follow it.
Firstly, great care must be taken when grouping patients together to receive the same airflow as they must have the same lung capacity to ensure the volume is evenly distributed. Secondly, the modifications have only been used for test lungs and animals with normal lungs. “In this particular infection [COVID-19], the lungs are not normal. That’s where most of the pathology is... so a lot of the dynamics will change substantially,” Babcock told Motherboard.
Although not tested in humans, it has been used on humans, Babcock remarked in the video. Dr Kevin Menes used the technique to save multiple lives whilst treating victims of the 2017 mass shooting in Las Vegas. So whilst Babcock still emphasized the risks of this “off-label” use of the ventilator, the method is “probably better than nothing in dire circumstances.”
In Canada, a recent study predicted that under a “conservative scenario” the country would run out of ventilators after a month and under an “Italy scenario” they would run out in just 16 days. Inspired by the work of Babcock and her colleagues, Dr Alain Gauthier, an anesthetist in Ontario, converted four anesthetic machines in his rural hospital to ventilate a total of eight people, to add to the one dedicated ventilator they also had.
"At one point we may not have other options," Dr Gauthier told CBC News. "The option could be well, we let people die or we give that a chance."
As Babcock pointed out in her video, “In an ideal world, we wouldn’t need to use this [modified ventilator] today or tomorrow.” But by sharing her information she hopes to spark a discussion into alternative ways to save lives with the equipment available. As scientists continue to work tirelessly to provide treatments, vaccines, and answers to battle this deadly virus, innovation is vital.