So far, Mount Sinai Health System in New York City has had enough ventilators to meet the growing demand due to COVID-19.
But, if the hospital gets overwhelmed, it has an unlikely backup: sleep apnea machines.
More and more hospital systems are looking for ways to shore up their supply of ventilators and have turned to converted sleep apnea machines. Mount Sinai, a system of eight hospitals, has set up its own conversion system to transform a donation of 500 BiPAP machines used to treat sleep apnea to shore up their ventilator capacity.
"It has given us a little reassurance that even as demand goes off and we use more ventilators, this is an arsenal we can tap into to magnify and help our existing fleet," said Robert Freeman, vice president of clinical innovation at Mount Sinai.
David Rapoport, an expert in sleep medicine and critical care for Mount Sinai, put together a clinical protocol on how to convert sleep apnea machines.
Then, a group of medical students and volunteers turned one of the floors in Mount Sinai’s system into a ventilator assembly area, Freeman said.
“A whole community came together of students, researchers, simulation lab folks to make this happen,” he added.
There are some challenges with converting the devices into makeshift ventilators.
For one, the devices are only supposed to be used for people who don’t need a heavy-duty, hospital-grade ventilator. They are to be employed when a patient is coming off a ventilator but still may need breathing assistance, Freeman said.
The devices, though, can help free up the “powerhouse critical care ventilators for the sickest patients,” Freeman added.
A major issue is also ensuring that the ventilator doesn’t leak any of the virus or aerosolize the virus in a way that puts staff and other patients at risk.
“We wanted to make sure we can get the right filters on there to make sure there was no aerosolization,” Freeman said.
Mount Sinai also had to figure out how to connect the device to the right type of monitor to trigger alarms to alert healthcare workers.
But the hospital system isn’t the only one figuring out how to properly convert sleep apnea machines.
A team of doctors and engineers from the University of California (UC), San Francisco and UC Berkeley have launched a nationwide effort to solicit the donation of home-based, off-the-shelf sleep apnea machines from consumers to their local hospital.
So far, the effort led by the group called the COVID-19 Ventilator Rapid Response Team has gotten between 700 and 1,000 units since the effort was launched last Friday.
The team plans to employ a logistics supplier to distribute the machines to hospitals that need them across the country alongside information on how to convert the machines using simple off-the-shelf parts.
The team’s goal is to get the machines to hospitals in a matter of weeks.
“We are trying to run a test immediately where a hospital calls us up and we will take units from the registry, supply them to a hospital, ship a box of the pats and a video to help people assemble them,” said Bryan Martel, the team organizer and co-founder of Berkeley Engineering and Research Inc.
He added that the group needs input from state and federal governments on which hospitals may need them.
The team is also hoping to get speedy approval from the U.S. Food and Drug Administration, which typically restricts modifying medical devices for a use other than the one they were approved for. The agency has issued new guidance to enable sleep apnea machines used in hospitals to be converted to ventilators.