Written by: Daniela Rus
When COVID-19 struck in early 2020, hospitals everywhere were suddenly overloaded with patients—and in desperate need of ventilators. Two questions loomed around the globe: How do you create a ventilation system rapidly? And what can be done quickly enough to save lives?
There was no easy answer. One of the greatest challenges when caring for COVID patients is that treatment typically requires two or more weeks of constant ventilation via a mechanical ventilator. These machines, which range in price from $25,000 to $50,000 a unit, use sophisticated mechanisms to respond to patients’ breathing patterns and other vital signs. The only other available means of ventilation: a manual ventilator bag designed to be used for minutes—not weeks—at a time, and that requires a trained healthcare provider to maintain oxygenation by constantly squeezing and releasing the bag for the duration of treatment. To address the crisis, a stopgap solution was needed that could be designed, tested, approved, manufactured, and distributed in a matter of weeks. It seemed an impossible quest.
At MIT, however, we knew precisely where to begin: in the half-forgotten files of MIT mechanical engineering professor Alex Slocum, whose student-faculty research team had designed an early version of an emergency ventilator a full decade ago. Basically a manual ventilator in a plastic box, the original design used a battery and motor to automate the manual compression process. Though innovative at the time, the simple design was far from sufficient for today’s needs, lacking a manufacturable design, reliable controller, feedback mechanism, alarms, and extensive testing—all of the components necessary to provide doctors with a reliable and intuitive instrument.
But it was a start. We quickly began expanding the basic design to create a mechanism capable of converting Ambu resuscitation bags, the most commonly available manual ventilators, into mechanical ventilators that could safely ventilate COVID patients. Among our challenges was the issue of safe inflation of the ventilator bag. During manual inflation, there is dangerous potential to over-pressurize a patient’s lungs. We needed to create an emergency ventilator that was accurate enough to protect patients from this type of lethal damage.
To solve the challenge, Prof. Alex Slocum and I worked with our team to develop a robotic hand squeezer that is gentle enough not to puncture the Ambu bag, yet strong enough to effectively ventilate a patient’s lungs. Our team then refined the design to ensure the device could respond to feedback and achieve the required torque using a gauge that stops the flow of oxygen before the pressure gets high enough to cause damage to the lungs.
Taking a design from a research prototype to an approved, usable product is always a challenge—especially when human lives are at stake—and creating the mechanism itself was just the first step in the process. To accelerate development and quickly provide a solution to healthcare providers around the world, we made the designs available online, for free, in an open source format. Just weeks after forming our team and diving into the project full force, a commercial-grade manufacturable system was developed and received emergency use approval (EUA) from the FDA.
Now called the MIT Emergency Ventilator Project, the approved design enables manufacturers to shift existing production lines to quickly create ‘bridge’ devices that can help save lives when mechanical ventilators are not available. Already, the results are more than promising. Companies like 10XBeta and VecnaCares are now manufacturing and distributing devices based on the MIT solution. The 10XBeta devices are already in use at numerous hospitals in New York, and we expect to see this usage expand as more companies take advantage of the free, open source design to create emergency ventilators in the US and abroad to address this great need. The low cost of the devices should help support that expansion. The cost for a fully manufactured bridge ventilator from the VecnaCares Ventiv program, for example, is available for just $950 per unit—a mere fraction of the cost of a commercial-grade mechanical ventilator.
While this stopgap design is not a long-term replacement for an FDA-approved ICU ventilator, it does offer the functionality, flexibility, and clinical efficacy needed to provide respiratory care when mechanical ventilators are unavailable. Until we eradicate COVID-19, hospitals in hard-hit communities in the US and abroad continue to face ventilator shortages, forcing physicians to triage patients to decide who receives care and who doesn’t. Devices built on the design of the MIT Emergency Ventilation plans may well make the difference between life and death for COVID patients around the globe.
Thankfully, MIT is not alone in our efforts to alleviate the shortage of ventilators amid the COVID crisis. Research teams at other top institutions are working day and night in search of other usable solutions.
Here in the US, researchers at Stanford are working with the Chan Zuckerberg Biohub to create a simplified ventilator. At Villanova, researchers are partnering with Children’s Hospital of Philadelphia and Geisinger Health System to create another type of low-cost emergency ventilator. In other regions, volunteers in the Czech Republic recently used crowdfunding to raise funds for the development of a ventilator called Corovent, and the Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST) in India recently announced the development of an easy-to-operate Emergency Breathing Assist System (EBAS). On the manufacturing side of the equation, Tesla, SpaceX, Dyson, GM, and Ford are among the growing list of companies that are exploring methods to convert existing manufacturing facilities to build emergency ventilators similar to the MIT Emergency Ventilation.
COVID-19 is putting society to the test in many ways. The efforts of researchers and manufacturers around the world illustrate our collective commitment to solving today’s most urgent challenge, and bridge devices to provide emergency ventilation solutions are just one of many projects in development to address the pandemic. Toward that goal, our team at MIT is now working on a variety of technologies to help prevent the spread of COVID-19 and, ultimately, to eradicate the disease. Among the most promising: a UVC robot that safely disinfects spaces without human interaction; a privacy-preserving contact tracing solution to help prevent the spread of the virus; and a method that uses machine learning to accelerate the development of new vaccines. Our hope is that through collaboration with our fellow researchers, the medical community, local policy makers, and manufacturers of all kinds, and by applying the power of robotics and AI in new and innovative ways, we can relegate COVID-19 to history once and for all—while saving as many lives as possible along the way.
About the Author: A member of the ROBO Global Strategic Advisory Board, Daniela Rus is the Director of CSAIL at MIT. She serves as the Director of the Toyota-CSAIL Joint Research Center and is a member of the science advisory board of the Toyota Research Institute. Rus’s research interests are in robotics and artificial intelligence. The recipient of the 2017 Engelberger Robotics Award from the Robotics Industries Association, she is also a Class of 2002 MacArthur Fellow, a fellow of ACM, AAAI and IEEE, and a member of the National Academy of Engineering and the American Academy of Arts and Sciences. Daniela earned her PhD in Computer Science from Cornell University.