NEW YORK (Reuters) – At least one New York hospital has started putting two patients on a single ventilator. An experimental crisis mode protocol that some doctors find too risky but others consider necessary because the coronavirus outbreak is draining medical resources.
The corona virus causes a respiratory disease called COVID-19, which can damage the lungs in severe cases. In New York City, which has nearly 22,000 confirmed cases with one of the largest number of cases in the world, at least 281 people were killed within a few weeks.
A mechanical ventilator is a last resort tool in which a tube is threaded over a patient’s trachea. It can support a person who can no longer breathe without help. The city has only a few thousand and tries to find tens of thousands more.
Dr. Craig Smith, chief physician at New York’s Presbyterian / Columbia University Medical Center in Manhattan, wrote in a newsletter to employees that anesthesia and intensive care teams worked “day and night” to get the split ventilation experiment going.
By Wednesday, he wrote, there were “two patients who were carefully treated with a ventilator”.
New York governor Andrew Cuomo, who says his employees are having trouble finding enough machines on the market, has touted the adjustment as a potential lifesaver. “It is not ideal,” he told reporters, “but we believe it will work.”
The U.S. Food & Drug Administration, which regulates medical device manufacturers, issued an emergency approval on Tuesday that allows ventilators to be modified using a splitter tube to treat multiple COVID-19 patients. However, manufacturers still need to share safety information with regulators.
Some medical associations reject the unproven method.
On Thursday, the Society of Critical Care Medicine, the American Association for Respiratory Care, and four other groups of practitioners made a joint statement saying that the practice “should not be attempted because it cannot be performed safely with current equipment “.
It is difficult enough to optimize a ventilator to keep even one patient with acute respiratory distress syndrome (ARDS) alive. Splitting across multiple patients would worsen the results for everyone. They suggested that doctors instead choose the one patient per ventilator that is most likely to survive.
In Columbia, Smith found that they could not split a ventilator between two COVID-19 patients, but only matched patients with sufficiently similar breathing needs.
Across Manhattan, Mount Sinai Hospital emailed employees that officials were “working” to find out if they could share ventilators. The hospital has ordered the necessary adapters, a nurse said in an interview on condition of anonymity because she was not authorized to speak to reporters.
FILE PHOTO: A ventilator can be seen in New York’s Emergency Management Warehouse, where 400 ventilators have arrived and were shipped for distribution prior to shipment due to concerns about the rapid spread of coronavirus disease (COVID-19) in Brooklyn, New York City , USA, March 24, 2020. REUTERS / Caitlin Ochs / File Photo
Experts in Columbia pointed to a study from 2006 in which researchers using lung simulators concluded that a single ventilator could support four adults in an emergency scenario.
An author of this study, Dr. Greg Neyman warned against use in COVID-19 cases, partly because the lungs themselves are infected. If a patient’s lungs deteriorated faster, this could lead to imbalances in the closed system. One patient may be hungry for oxygen while the other patient’s lungs are under increased pressure.
“If they are not closely monitored, such a facility can do more harm than good,” Neyman wrote to Reuters in an email.