ABCD offers solution to ventilator shortage during COVID-19 pandemic

The Artificial Breathing Capability Device, or ABCD, has been shown to be safe, efficacious, and cost-effective option for respiratory support, according to a study. It can be considered for adults and children when there is a shortage of ventilators especially during the COVID-19 pandemic.

“We developed the ABCD to automate compression of self-inflating bags (SIB), while controlling peak inspiratory pressure (PIP), ventilation rate (VR), and inspiration to expiration time (I:E) ratio, as in a conventional ventilator,” the researchers said.

A team of innovators led by Joseph L. Matthew from the Postgraduate Institute of Medical Education and Research in Chandigarh, India, developed and tested the novel ABDC, which was conceptualized in 2015, well before the COVID-19 pandemic, as a safer and more efficacious alternative to manual ventilation. [https://patentscope.wipo.int/ search/en/detail.jsf?docId=WO2019229776&_cid=P11-KACLNC-27872-1]

They completed the design and development of the device during 2016–2018 and filed for patent application in May 2018. [https://www.who.int/medical_devices/global_ forum/73_Artificial_Breathing_Capability_Device_novel_ life_s aving_device_limited_resources.pdf]

ABCD boasts of additional smart features, such as self-regulatory checks, auto cut-off during cough, endotracheal tube disconnection and blockage alarms, and SIB disconnection alarm. It was tested nonstop for 60 days with 396 user combinations, using adult- and paediatric-size SIB. Finally, the device was assessed for its robustness, reliability, and precision.

As a result, ABCD performed satisfactorily, exhibiting robustness with no mechanical, electrical, or electrical failures during continuous testing under various ambient conditions. [BMJ Innovations 2021;7:40-46]

Reliability and precision assessed by the proportion of user combinations showing <10-percent deviation from the set of parameters demonstrated 100-percent PIP, 100-percent VR, and 84.3-percent I:E with an adult SIB. For a paediatric-size SIB, the respective proportions were 85.4 percent, 100 percent, and 95.5 percent. Notably, the only combinations showing >10-percent deviation with both SIB were outside the physiologic range. [www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0040-1713719.pdf]

“The present version of the device can deliver PIP in the range of 10 to 50 cm H2O, VR in the range 10–60 per minute, and I:E ratio in the range 1:1 to 1:4 (with any fraction in between),” the researchers noted. “This covers most clinical situations requiring respiratory support.”

Additionally, ABCD features an exhalation valve located just distal to the endotracheal tube. With this, the risk of rebreathing expired air is removed. A pressure sensor is also fitted at the same location, which enables the recording and real-time display of the delivered pressure, rate, and inspiratory time with each breath.

“Although the ABCD is safer and more efficacious than manual ventilation, and well ahead of the current wave of devices compressing ambu bags, it requires further refinements to make it suitable for the ventilatory needs of COVID-19 patients,” the researchers said. “This process is currently underway and ABCD 2.0 is expected to be available for clinical testing in 2 to 3 months.”

Matthew conceptualized the device and its clinical specifications, observed manual ventilation for several weeks to identify the user needs, secured funding, supervised the development and clinical testing of the device, drafted, and finalized the manuscript. He also contributed funds from personal resources during the early design and development phase.