If the desperate need for ventilators wasn’t already clear, New York Gov. Andrew Cuomo brought it to the nation in a speech aired widely Tuesday after the feds offered to send his state 400 of the breathing machines.
“What are we going to do with 400 ventilators when we need 30,000? You’re missing the magnitude of the problem,” Cuomo said.
That’s a big gap and there’s a simple fix, some would say a hack, to multiply the number of lives docs can save. A few people areound the world are working on it, among them, state Sen. Saud Anwar, a pulmonologist at Eastern Connecticut Health Network, the hospitals in Manchester and Rockville.
One ventilator, made to treat one patient at a time, apparently can still work with four patients at the same time with some quick, cheap plumbing work. It is, as one person called it, a modification right out of Apollo 13.
Anwar knew about the technique, described in a paper by two doctors in 2006. As far as he knows, it’s only been used once in the United States, after the horrific mass shooting at the Las Vegas Strip on Oct. 1, 2017, when a gunman killed 58 people and wounded more than 400.
Then in the middle of this month, one of the two who first wrote about the fix — Dr. Charlene Irvin Babcock in Detroit — posted a video showing how to do it. Anwar moved into action quickly and made it happen at Manchester Memorial Hospital, along with Marvin Bristol, a cardiopulmonary clinical educator at ECHN.
The dry run test with four simulated lungs was last week and it went great, Anwar said Tuesday.
“We are truly building this airplane as we fly,” he said.
The technique has had some media attention in Detroit and in tech publications. Anwar, who has a large following on Facebook videos, and has been active online in the coronavirus crisis, put it out it out to his network, with as many as 16,000 views.
“Most hospitals are getting ready to do this. We are using each other’s experience,” he said.
Most hospitals may be a bit optimistic. Hartford HealthCare showed a similar technique in an online presentation Tuesday in which a respiratory therapist connected two people to a “split ventilator.” Gov. Lamont also referred Monday to 2-for-1 efforts.
But four? A spokeswoman at Hartford HealthCare, parent of Hartford Hospital, St. Vincent’s Medical Center in Bridgeport and several other hospitals in Connecticut, said that’s not in the works. Likewise, Stamford Hospital isn’t looking at a four-way split right now.
It may well come to that. So far, the Connecticut hospitals have the ventilators they need to treat the patients they have. ECHN, for example, Manchester Memorial and Rockville General hospitals, has 16 ventilators. But as we’ve seen over the last three days, the patient numbers are rising fast. On Tuesday, Lamont said he has put out a call for hundreds of ventilators.
Anwar, a Democrat from South Windsor who was mayor of that town before he was elected to the state Senate, is an early adapter and is spreading the religion of the 4-way split. “I’ve been guiding people how to do this,” he said.
One concern: The technique has not been tested on live humans. In the Las Vegas emergency, the patients didn’t need long-term ventilation — as they do if they have COVID-19 — as one doctor pointed out in a story last week in Vice.
Babcock said in that article in Vice, “it’s probably better than nothing in dire circumstances.”
Anwar seems more confident it would work.
“One can get four patients on a single ventilator but it has to be done in an extremely focused manner,” he said. “The catch is that the four patients need to be of a similar size with similar illness and similar lung physiology.”
It looks simple in a video from Babcock, an emergency room physician at Ascension St. John Hospital in Detroit.
Using three T-tubes and three adapters, tubes are multiplied from the exhalation and inhalation sides. There’s some worry about cross-infection, but the machine has filters to take care of that. The patients need to be heavily sedated, or “medically paralyzed,” and the tubes need to be the same length.
“The air flows in the path of least resistance,” Anwar said.
Will it solve the ventilator shortage crisis that we saw with tragic results in Italy, as doctors had to let people die for lack of machines? Not entirely, but if Connecticut can play a role in early adaption, so much the better.
We hope it’s never needed. If the numbers happen the way epidemiologists warn — half or more of the population getting COVID-19, 15 percent of all patients needing hospital care and many of these in intensive care — the four-way split will save lives.
“The pulmonologists in our state and the critical care doctors in our state, they are going to be ready,” Anwar said.