Detroit doctor’s ventilator idea is getting global attention

Tribune Content Agency

DETROIT — A Detroit emergency physician’s 15-year-old idea — rigging one ventilator to assist two or more patients — is gaining global attention, as the novel coronavirus pandemic causes skyrocketing hospitalization rates and doctors face a critical shortage of the life-saving breathing machines.

Dr. Charlene Irvin Babcock, an emergency physician at Ascension St. John Hospital in Detroit, wrote a research paper with Dr. Greg Neyman in 2006, explaining that adaptations including T- or Y-shaped splitters on air flow tubes could allow a single ventilator to serve two people, four or even more.

“It was a very small article,” Babcock said. “It was really a feasibility, proof-of-concept study. At the time we did it, I didn’t think it was going to amount to much because the circumstances under which you would do co-venting — an overwhelming number of critical patients, not enough ventilators and no other options — didn’t seem likely.”

Amid the COVID-19 pandemic, however, that’s no longer the case. Babcock in mid-March posted a YouTube video explaining how to split a ventilator for multiple patients. The video had more than 925,000 views as of Wednesday.

“It’s kind of strange the medical community picked up on it from a YouTube video, not the paper,” she said.

In New York, America’s hardest-hit state by coronavirus, the New York Times reported this week that New York-Presbyterian Hospital in Manhattan has begun using Babcock and Neyman’s concept to split ventilators between two patients in need.

In Italy, which had seen upward of 13,000 coronavirus deaths, far more than any other country, emergency physician Dr. Marco Garrone tweeted photos of patients sharing ventilators last month.

“This is what we are down to — splitting ventilators, and facing serious dilemmas like choosing who will be actually ventilated when everybody should,” he tweeted March 20. “#TakeThisSeriously, bloody seriously. Never thought it was so bad.”

Detroit hospitals are at least considering the possibility of co-ventilation.

“We are on top of that also to see if we get to a situation where we need to kind of share these ventilators — we have all the equipment that we need to be able to share and continue to double or triple the capacity that we have at the present time,” said Dr. Adnan Munkarah, Henry Ford Health System’s executive president and chief clinical officer, on Friday.

Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at DMC Harper University Hospital, told the Free Press Friday that her facility had “a ton of regulators in storage.”

“When those are all out, we are also looking at splitting our ventilators like other facilities,” she said.

Beaumont President and CEO John Fox said last week that the hospital system was also looking at ventilator sharing.

“One of the challenges with that is a lot of these patients developed ARDS (acute respiratory distress syndrome) … and often they can be on the mechanical ventilator at maximum settings,” he said. “And it’s hard to share and get adequate ventilation with multiple people on a single machine on maximum. So we’ll definitely use it. I mean, it’s been done before. If that is a good way to extend our limited supply of mechanical ventilators, we’ll certainly be doing it.”

Babcock and Dr. Rene Franco, a pulmonary critical care doctor with Ascension in Detroit, were invited to Washington last week by the Federal Emergency Management Agency, to convene a COVID-19 Co-Ventilation Task Force, including other doctors and medical professionals familiar with the concept, to outline best practices. The U.S. Department of Health and Human Services on Tuesday put on its website the task force’s “Optimizing ventilator use during the COVID-19 pandemic” white paper — along with statements from the federal Centers for Disease Control and Prevention and the U.S. Food and Drug Administration expressing no objections to the practice on an emergency basis amid the pandemic.

Mechanical ventilation is typically reserved for patients in critical condition who are unable to provide their bodies with enough oxygen or have stopped breathing. It’s been a particular need for the worst of coronavirus patients.

Ventilators can be set two ways, Babcock said: volume control — telling the machine to deliver a specific volume of air to a patient’s lungs from breath to breath — or by pressure control, setting the machine to deliver a certain pressure of air, without specific regard to the volume of air in a patient’s lungs. Ventilator machines are capable of delivering much stronger pressures than are typically used — enough pressure that, if split among patients, they can deliver an adequate air supply.

It’s very important that patients at the same level of sickness are matched for ventilator splitting, as the breathing of one, if it’s stronger, will impact the air flow to another, Babcock said. The patients require near-constant monitoring, and changing from one shared respirator at a certain level to perhaps others, set differently, as their breathing improves or worsens. The practice requires the patients to be medically paralyzed while on the ventilator.

Babcock said she recommends that a ventilator be shared by no more than two people. “It can be very challenging and dangerous to adequately match people and adequately handle all of those changes in their breathing over time,” she said.

Ventilator-sharing was used by emergency physician Dr. Kevin Menes for the crush of injured in Las Vegas following the worst mass shooting in U.S. history, at a country music concert on Oct. 1, 2017. Menes had served his residency with Neyman, Babcock’s co-author on the 2006 study, and was familiar with the concept.

Ventilator-splitting is controversial. A significant contingent of doctors say its potential for germ transfers between patients, and negative impacts on an individual patient’s breathing caused by being connected to a machine with others, make it too much of a risk.

“This would be truly the ultimate last-ditch, and I’m not even sure I would do it as a last-ditch, “ said Dr. Mary Dale Peterson, president of the American Society of Anesthesiologists, based in Washington.

Using pressure-based ventilation on multiple patients “is like trying to blow up a football, a tire and a balloon at the same time,” Peterson said. “You might get too much air in one and not enough air in the other.”

It’s unlikely to have two patients at the exact same point of COVID-19 sickness, with the same lung capacity, she said. And even if such a match can be made in the chaos of an overwhelmed emergency room, a patient’s lung capacity can change from moment to moment, she said.

“You’re really doing a disservice to both (connected ventilator patients), in my opinion,” Peterson said.

The society instead is encouraging hospitals to utilize the ventilator capabilities on their anesthesia gas machines — a possibility that Munkarah of Henry Ford Health System said is also under consideration at Detroit hospitals.

Babcock largely agrees with her concept’s critics.

“When it comes down to it, in this pandemic, if you have no other options, it’s either a try-or-let-die situation,” she said.

Making the decision to split ventilators between patients requires difficult conversations with the patients or their families, Babcock said, “that point where you’re going to have to tell them, ‘We can use one vent for two patients, or we can make an agonizing decision and have one of them die.’

“I give a lot of credit to the people of New York who have done this and are doing this.”

The last-ditch effort of ventilator-sharing is a means to buy time, Babcock said, until efforts such as those by Ford Motor Co. and GE Healthcare to make 50,000 new ventilators in the next 100 days alleviate the critical shortage.

“It’s something I put out there in the hopes it would help people,” Babcock said. “To see it actually working, saving lives, it is unbelievable. But it’s also unbelievable that things have gotten so bad that they actually have to use this.”


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