Members of the Mount Sinai team that created the ventilator prototype seen here, included, from left, Drew Copeland, RPSGT; Thomas Tolbert, MD; Brian Mayrsohn, MD; and Hooman Poor, MD.
A team of pulmonologists, anesthesiologists, sleep and critical care specialists, and medical students at the Mount Sinai Health System are reconfiguring hundreds of donated machines that are typically used at home for sleep apnea and deploying them as ventilators to be used for severely ill patients who are hospitalized with COVID-19. Mount Sinai has shared the protocols and instructions with the Greater New York Hospital Association and the American Thoracic Society, as well as with other hospitals that are dealing with a national shortage of invasive ventilators during this pandemic. COVID-19 affects the respiratory system and has greatly increased the number of patients who are entering intensive care units and require assisted breathing.
When Mount Sinai received a shipment of 200 ResMed VPAP ST machines as a donation from Elon Musk, Chief Executive Officer of Tesla, Inc., in late March, a Health System task force was immediately organized to repurpose them. Within several days, the team put together a prototype that was tested in the Simulation HELPS Center at Mount Sinai, a unique laboratory run by the Department of Anesthesia that enables clinicians to simulate human responses to innovative technologies and procedures.
Three important modifications were made by the Mount Sinai team. First, a connection to an endotracheal tube replaced the typical mask that can present a risk of COVID-19 aerosolization; second, alarms that can alert clinicians if there is a problem with air flow were included; and third, the team enabled doctors and respiratory therapists to view and control the machine’s settings from outside the patient’s room, so they do not need to enter the room to make minor adjustments.
These VPAP machines will be used as an option under the current circumstances at Mount Sinai to prevent a shortage of invasive ventilators needed to serve the ongoing surge of patients. They are preferable to splitting invasive ventilators that serve two patients at the same time, a move that many hospitals are concerned they may have to pursue as a last resort.
Among the clinicians leading the effort at Mount Sinai is Charles A. Powell, MD, Janice and Coleman Rabin Professor of Medicine, Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine, and Chief Executive Officer of the Mount Sinai – National Jewish Health Respiratory Institute. Dr. Powell says the machines can be used “in patients who do not require all the power of a regular ventilator, freeing up those conventional devices for the acutely ill.” He adds, “Our objective is to share our protocols widely with our colleagues around the globe facing this crisis. This project is a demonstration of the success of the team science collaborative research infrastructure at Mount Sinai that allowed us to make these innovations quickly.”
Any type of high-performing sleep device that delivers a comparable level of pressure to the ResMed VPAP ST model can work as a repurposed ventilator, according to Drew Copeland, Director of Operations for the Sleep Program at the Mount Sinai Health System. He says, “For many patients, this can save their life. We are not yet at a critical mass for ventilators but we may be getting there. This is a moving target. Hopefully, we can keep pace.”
After the first prototype was developed, Mr. Copeland enlisted a team of medical students from the Icahn School of Medicine at Mount Sinai to write the instructional user manual. They completed it in one day.
The students are now assembling the machines to be used throughout the Health System’s eight hospitals in the event of a shortage of invasive ventilators. Two floors of the medical school’s library have been set up as a staging area for the makeshift assembly line. The goal is to have all of the machines ready to be deployed by the end of this week.