Rapidly scalable mechanical ventilator for the COVID-19 pandemic

The SARS-CoV-2 pandemic is straining healthcare systems worldwide, and a global ventilator shortage is fueling the dire situation. As a response, the MIT E-Vent Team (S1) manufactured a scalable ventilator prototype for mass production and demonstrated basic clinical feasibility.

MIT E-Vent engineering information and capabilities, but also missing safety features are provided on the MIT E-Vent website (https://e-vent.mit.edu/) and in the attachments (Fig. 1a, S2). Pressure-based alarms were implemented including in the `Spiro Wave’ device that is based on the MIT E-vent and was just authorized for emergency use by the US FDA. In brief, the MIT E-Vent houses a manual resuscitator, an external compression mechanism, and a control system for adjusting tidal volumes, inspiration-to-expiration ratio, and respiratory rate (Fig. 1a, S3, S4). The MIT E-Vent is equipped with a pressure relief and a positive end-expiratory pressure (PEEP) valve. It delivers unassisted (Fig. 1b) and assisted (not shown) volume control ventilation (VCV). As a proof of concept, a pig was ventilated with the MIT E-Vent or a standard mechanical ventilator (SMV) at distinct settings and arterial blood gases, ventilator waveforms, and flow-volume loops were obtained.

The MIT E-Vent performed similar to a SMV at identical respiratory settings. After 36 h of usage including at high demand settings (TV 600 cc, RR 30, PEEP 20), no signs of device failure were noted (S5).

Tidal volume delivery

MIT E-Vent waveforms showed a smooth tidal volume delivery (Fig. 1b). It revealed similar flow-volume loops when compared to manual ventilation using a manual resuscitator (Fig. 1c).

Gas exchange

MIT E-Vent settings were changed to achieve ‘low’ and ‘high’ minute ventilation, and ‘low’ and ‘high’ FiO2 states as reflected in the ABGs (Fig. 1d, e).

Fig. 1

MIT E-Vent. Prototype design (a). Waveforms and flow-volume loops (b and c). Ventilation (d) and oxygenation testing (e)

The MIT E-Vent provides (un-)assisted VCV, variable MV, and PEEP with airway pressure profiles comparable to a SMV. The MIT E-Vent is not equipped to provide pressure control ventilation (PCV), which may make it unsuitable for awake and the most complex ARDS patients. However, this device is meant as a bridging tool when a conventional ventilator is not available, to serve as ‘destination ventilator device’ in the absence of any alternatives, or to help free up SMV in certain cases.

The MIT E-Vent Team was determined to equip the MIT E-Vent with comprehensive safety features including oxygen and flow sensors, but due to widespread hardware supply shortages, this became impossible. Omitting these safety features was deemed necessary to provide a rapidly scalable prototype. Consequently, increased clinical monitoring is required to provide adequate safety during the use of the MIT E-Vent (S2). Despite these limitations, the MIT-E Vent offers basic mechanical ventilation for selected patients during this ventilator shortage.

The MIT E-Vent Team invites the global community to improve and distribute a version of this scalable, low-cost ventilator during this COVID-19 pandemic.

Oxygenation and ventilation capabilities of a scalable, low-cost ventilator were demonstrated. MIT E-Vent engineering documentation was made public to rapidly implement the MIT E-Vent into the clinical care of patients requiring invasive mechanical ventilation.

MIT E-Vent Team

MIT E-Vent Engineering: Brandon Araki – PhD Candidate, Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT Murad Abu-Kalaf, PhD – Research Scientist, Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT Mike Detienne, BS – MIT Alum (Electrical Engineering) David Hagan, PhD – CEO, QuantAQ; MIT Alum, (Atmospheric Physics & Chemistry) Nevan Hanumara, PhD – Research Scientist, Mechanical Engineering, MIT (Alum) Kimberly Jung, MS, MBA – MIT Alum (Mechanical Engineering) Teddy Ort – PhD Candidate, Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT Aaron Ramirez – PhD Candidate, Mechanical Engineering, MIT Folkers Rojas, PhD – Founder, Raptor Designs; MIT Alum (Mechanical Engineering) Daniela Rus, PhD – Director, Computer Science and Artificial Intelligence Laboratory (CSAIL), MIT Amelia Servi, PhD – R&D Engineer, Creare, LLC; MIT Alum (Mechanical Engineering) Shakti Shaligram, MS – Research Scientist, IDM; MIT Alum (Integrated Design and Management) Alexander Slocum, PhD – Professor of Mechanical Engineering, MIT Jonathan Slocum, ScD – MIT Alum (Mechanical Engineering) Alexander Slocum, Jr, MD PhD – Department of Plastic & Reconstructive Surgery, Medical College of Wisconsin; MIT Alum (Mechanical Engineering) Coby Unger, BS; MIT Hobby Shop. MIT E-Vent Clinical Team: Jay Connor, MD – Orthopaedic Surgery, Mt Auburn Hospital Bon Ku, MD – Assistant Dean for Medical Education and Associate Professor of Emergency Medicine, Thomas Jefferson University, Sidney Kimmel Medical College Albert Kwon, MD – Assistant Professor of Anesthesiology, Department of Anesthesiology, Westchester Medical Center, New York Medical College Christoph Nabzdyk, MD – Assistant Professor of Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester Alexander Slocum, Jr, MD PhD – Department of Plastic & Reconstructive Surgery, Medical College of Wisconsin Dirk Varelmann, MD – Assistant Professor of Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School. Clinical Advisors: John Callahan, MD - Internal Medicine, St. Joseph’s Hospital Health Center & Veterans Administration Hospital, Syracuse Sergey Karamnov, MD - Instructor of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School Keith G Lurie, MD – Professor of Emergency Medicine, University of Minnesota Niels Olson, Lt Cmdr, MD – Laboratory Medical Director, US Naval Hospital, Guam; Professor, Uniformed Services University Neil Ray, MD – Anesthesiologist; Founder & CEO, Raydiant Oximetry Mark Rosen, MD – Professor of Anesthesiology (Ret), University of California, San Francisco; CMO, Raydiant Oximetry Steven Shafer, MD – Professor of Anesthesiology, Perioperative and Pain Medicine, Stanford University Scott Sparks, Lt Col, MD – Anesthesiologist, US Naval Hospital, Guam. Manuscript Composition and Editing Leena: Pradhan-Nabzdyk, PhD, MBA - Assistant Professor of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School. 2010 2.75 Project Team: Amelia Servi, PhD – R&D Engineering, Creare, LLC Abdul Mohsen Al Husseini, PhD – Co-Founder & Chief Strategy Officer, Analytical Space, Inc. Justin Negrete, MS – Thermal Engineer, Ford Motor Company, Inc. Stephen Powelson, BS – Senior Mechanical Engineer, Rani Therapeutics, LLC Heon Ju Lee, PhD - Executive Director, Kyperion Co. Ltd.

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Correspondence to Christoph G. S. Nabzdyk.

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Kwon, A.H., Slocum, A.H., Varelmann, D. et al. Rapidly scalable mechanical ventilator for the COVID-19 pandemic. Intensive Care Med 46, 1642–1644 (2020). https://doi.org/10.1007/s00134-020-06113-3

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