A Different Vehicle for Breathing Support in Patients with COVID-19

If you had access to a Ferarri, what use would you have for a Beetle? 

For Paul Dorian, a professor of medicine at the University of Toronto, the beauty of the "people's car" lies in its simplicity.  

“They can't go as fast as a sports car, but they’re extremely reliable. You could practically fix them with band-aids, paperclips and elastics when they break down and they last nearly forever,” he says.  

Like the durable vintage Volkswagens, Dorian says the Oxylator — a handheld emergency device for heart and lung resuscitation — is reliable, compact and easy to use. 

And, he says, it may be a useful vehicle for breathing support during a ventilator shortage as COVID-19 cases continue to rise.  

"Like a Ferarri, a ventilator is sophisticated, expensive and takes a lot of training to operate,” says Dorian. “But you can teach someone in an hour how to operate an Oxylator. Plus, they’re portable, indestructible and don’t need electricity.” 

Dorian, who is also a clinician-scientist at St. Michael’s Hospital, Unity Health Toronto, had previously studied the gas-powered gadgets for use in cardiac arrest.  

He reached out to ventilation expert Laurent Brochard, professor of medicine and clinician-scientist at St. Michael’s Keenan Research Centre for Biomedical Science, to test the Oxylator in a bench model that simulates a lung damaged by COVID-19. 

The team also tested the machine in an animal model.  

“Not only did it work nearly as well as a ventilator, but it turns out that the benefits we suspected, like simplicity, ease of use, reliability, durability and expense were proven,” says Dorian. 

According to Dorian, the field devices cost about 50 times less than a ventilator, which can carry a price tag of about $75, 000. 

Applying the device for COVID-19 occurred to Dorian while he was behind the wheel of his own vehicle, driving home from Florida last March as the novel coronavirus began to spread globally. 

Health officials at the time were warning the number of patients with serious breathing complications could outstrip the supply of ventilators, and hospitals in other countries were overwhelmed by demand for the medical equipment.  

A ventilator shortage has not yet materialized in Canada, but it’s still a threat. And Dorian says there’s potential for the devices to be used in remote communities where there aren’t any ventilators. With the help of Art Slutsky, a professor of medicine and surgery, his team is also working to find out whether the Oxylator can deliver ventilation that’s gentle on the lungs. 

“When people receive mechanical ventilation from a ventilator over a long period of long time, the act of pushing air into people’s lungs can damage the lungs,” says Dorian. “Because of the way the Oxylator’s technology works, we believe this method may be particularly good at lung-protective ventilation.” 

A caregiver such as a nurse, physician, respiratory therapist or ambulance attendant needs to monitor the patient at the bedside during Oxylator use. 

There are already about 15,000 of the devices in use around the world, mostly in ambulances, helicopters and military units. 

Dorian and his colleagues are now looking at whether the Oxylator would be most helpful to the people who are most sick with COVID-related lung disease, and if they would be useful in healthier patients who need ventilation for other reasons, like recovery from surgery. 

The research was supported by the University of Toronto’s COVID-19 Action Fund, St. Michael’s Hospital Foundation and CPR Medical Devices, which makes the Oxylator.