— Robert L. Read, PhD, Nariman Poushin, Keeshan Patel, Stacey Oliver Sarris and Andrea Ippolito
At this moment…
There are thousands of intelligent, diligent, well-meaning engineers trying to help the design of open source ventilators to address a possibly imminent life-threatening shortage caused by the COVID-19 pandemic. This wealth of creative technical energy is currently disorganized, scattered, and unfocused. Rather than being a tremendous force for saving lives that it may become, energy and time is currently being wasted on oversimplifications of the problem and the belief that the projects are closer to deployable than they really are.
We have been working on this full-time only for the last eight days. With great humility, we would like to assert a few things.
There are Few Open Projects Ready for Volunteers
Right now there are four projects better defined than others:
- Low-Cost Open Source Ventilator is buildable, pressure tested, and active. We recommend that project and its creator, Johnny Lee, be given all the money and volunteer assistance it needs.
- The Rice OEDK Design: ApolloBVM, is buildable from the write-up and pressure tested, but not active.
- Open Source Ventilator — OpenLung BVM Ventilator is a well-organized, active, fully open project, but as of this writing not buildable.
- There is another project (Protofy Team OxyGEN) which is buildable and active but not pressure tested.
The situation may change quickly, but right now these four projects are the only projects that are even minimally actionable.
Other closed projects have been reported in the news and we wish them well, but if a project has not published a design, it cannot be considered a real open source project welcoming volunteers.
The Complexity of the Problem is Underestimated
At least some engineers seem to have undertaken or thought about undertaking projects without sufficient understanding of the problem. We consider the four links below essential reading. They are about 50 pages in all, and should take at most two hours to read:
- Rapidly Manufactured Ventilator System
- U.S. ICU Resource Availability for COVID-19
- OSCMS — Ventilator Machines
- Informal notes from a pulmonologist
People are rightly focused on prototypes, but must soon focus on testing. Without extensive, rigorous testing, no ventilator can be deployed.
Testing will be 90% of the effort in saving lives through open source ventilators.
Eight days ago we did not know what ventilator induced barotrauma is. Now we know: if a ventilator puts a little too much pressure on a sick person’s lungs, they will be injured in their weakest hour and may die. The same is true of too much volume. You cannot easily blow too much air into a strong, conscious person’s lungs, but you can easily kill a weak, unconscious person on a ventilator by doing so. Patients in general need many forms of breathing assistance, such as simple supplemental oxygen. But COVID-19 patients sometimes have ARDS and require complete intensive ventilation for up to a week or more in an ICU. A machine to do that safely is MUCH harder to make than a machine that moves air periodically. This is why our team at EndCoronavirus.org (NECSI) have specifically emphasized testing, and proposed a systematic testing process that might give a clinician sufficient confidence to deploy an open source ventilator.
Weighing The Risk
That extreme risk and life-critical nature makes DIY, open source ventilator designs a solution of last resort. Let us emphasize that: LAST RESORT. When an open source ventilator is needed, if it is not fully tested, reliable, and easy-to-use by a clinician wearing personal protective equipment, we risk costing lives rather than saving them.
How to Help
But the last resort may come upon us, so we are supporting the design, testing, and manufacture of open source ventilators. We have slowly learned how difficult this task will be, and what a challenge it will be to do quickly. But it is worth doing, and it may need your help.
If you are a firm that can manufacture electromechanical devices:
- Please see the University of Cambridge’s recommendations.
If you are an engineer:
- Do your homework.
- Offer to help an existing project.
- Focus on testing and reliability.
If you feel called to design your own ventilator (and we do need more designs):
- Do your homework.
- If you build something, publish the design fully with open licenses, even as you are developing it. If there is no published design, it is useless to the community.
- Plan to have others build your design as a test of your design documentation.
- Think in terms of manufacturing units on at the scale of hundreds or thousands or more. Assume that others will assist you financially in this if you publish a clear, well-tested design.
If you are a donor:
- Thank you! Buy equipment and supplies for teams that are open and have done their homework.
If you are a medical professional:
- Be patient with the engineers, but educate them on risks and critical performance features. Join a project and provide guidance.
- Help ALL of the community understand how to seriously address this crisis.