American Medical Associations Advise Against Splitting Ventilators Between COVID-19 Patients

The United States, a super power that boasts of immense military prowess, ironically does not have enough ventilators to help its citizens during a critical medical crisis. As per The New York Times, only 160,000 ventilators are available in the country of 327 million people. 

A patient with COVID-19 can develop respiratory illnesses and need a ventilator to help pump oxygen from the lungs, without which the patient might pass away. As per the American Hospital Association, 960,000 people will require ventilators in the U.S. as the pandemic escalates further and peaks. 

We might be nearing that situation. Doctors in New Orleans say they are going to run out of ventilators by next week as the entire city is equipped with only 500 to 600 devices. To tackle the crisis, these doctors are contemplating dividing the capacity of one ventilator between several patients. In New York, doctors offering critical care have started the practice of splitting ventilators already. 

But do they have a choice? The arduous process of manufacturing ventilators, testing and approval takes years. The other option is to selectively provide life-support to patients as Italy did. On the contrary, the doctors who either believe they are not authorized to make such decisions or want to show some humanity at their own risk, have to simply reconfigure these machines by connecting more pipes and adjusting the settings accordingly.

The idea gained some traction when a researcher demonstrated the positive effect of multiple users for single ventilators in a YouTube tutorial. He worked on a feasibility study determining if the concept worked in the aftermath of 9/11 and Hurricane Katrina. However, this was not approved by the Food and Drugs Administration (FDA) and was only tested on lung simulators, not on real people. Medical associations in the U.S. are not too happy with the decision of some doctors who make several patients share ventilators. 

Mechanical Ventilator An IPV (Intrapulmonary Percussive Ventilator) machine which is used by critically-ill patients. Creative Commons

What The Associations Said

In this regard, several medical associations have issued a joint statement regarding this practice on March 26. In a joint consensus they said sharing mechanical ventilators is not safe with the current equipment in use in the U.S. They cautioned that even in ordinary circumstances acute respiratory distress syndrome (ARDS) comes with a mortality rate between 40 to 60 percent. 

The six organisations who issued the advisory are:

  • The Society of Critical Care Medicine (SCCM) 
  • American Association for Respiratory Care (AARC)
  •  American Society of Anesthesiologists (ASA)
  •  Anesthesia Patient Safety Foundation (APSF) 
  • American Association of Critical‐Care Nurses (AACN) 
  •  American College of Chest Physicians (CHEST)

The association advised using the ventilator at its maximum for one patient, rather than failing to serve multiple patients with different requirements. A central hub and spokes model is used to re-position people around the ventilator in a circle. This rearranging does not give the patients at either end equal opportunity to draw oxygen, they said. 

“It also places the patients in proximity to each other, allowing for transfer of organisms. Spacing the patients farther apart would likely result in hypercarbia,” the associations said in their statement.

“Even if all patients connected to a single ventilator have the same clinical features at initiation, they could deteriorate and recover at different rates, and distribution of gas to each patient would be unequal and unmonitored.The sickest patient would get the smallest tidal volume and the improving patient would get the largest tidal volume,” they explained in their statement.

On March 27,  President Donald Trump invoked the Defense Production Act, therefore forcing General Motors (GM) to repurpose factories to make as many ventilators as possible. The auto company is collaborating with another company that manufactures ventilators in Seattle to speed up production at their auto-electronics plant based in Indiana.

The company said in a statement that they will make 10,000 ventilators per month starting in April and plan to increase capacity as they move along. Trump said at a press conference that he is pressing more manufacturers to meet the increasing demand for ventilators at American hospitals.