Crisis breeds creativity

In response to a call for help from nurses in northern Italy, a group of students studying for a master’s in Technical Medicine embarked on a project for designing emergency ventilators for Covid-19 patients – in record speed.

Tekst: Gert-Jan van den Bemd | Translated by Tony Parr | 8 april 2020

5 minutes

Professor Jaap Harlaar is the Director of Studies of both the bachelor’s degree in Clinical Technology and the master’s degree in Technical Medicine (courses operated jointly by Delft University of Technology, Leiden University Medical Centre and the Erasmus Medical Centre). He remembers seeing the harrowing scenes on television of nurses having to decide which patients to place on a ventilator. ‘The shortage of ventilators meant that nurses were forced into making life-or-death decisions. I could hear the fear in their voices. It was a truly awful predicament.’

Teamwork

With many of his master’s degree students left without research projects due to the coronavirus crisis, Professor Harlaar realised that an opportunity beckoned. He called his students together – most of them by video link – and suggested that they should join forces to find a safe, quick way of producing ventilators. The response was tremendously enthusiastic. Operation AIR was born. A number of teams were formed for maximum efficiency. Professor Harlaar: ‘Each team worked on a different aspect. There were teams for design, functionality and safety, hardware and software, production planning, legal aspects, and user training. The students also looked at the finances, the management side and internal and external communications. They were assisted by lecturers from the Erasmus MC (including Peter Somhorst, see below) and the LUMC. Various firms and other organisations also offered to share their expertise free of charge.’

Prof. dr. ir. Jaap Harlaar (links) en Peter Somhorst testen het apparaat - Image by Levien Willemse

Emergency ventilator

Professor Harlaar: ‘We wanted to design a simple, safe and relatively cheap ventilator in the shortest possible space of time. You need to bear in mind that we were aiming to produce an emergency ventilator – equipment that could be used as a back-up during the coronavirus crisis. The idea was not for it to replace standard hospital equipment, but that it should help make up for the shortage of ventilators.’ ‘We wanted to produce a ‘light’ version of a ventilator, including all the features required to ventilate Covid-19 patients. But that doesn’t mean that our machine, which we are calling the AIRone, is a low-tech piece of kit. It’s actually very sophisticated. There’s one key difference with a standard ventilator: our machine delivers breaths to the patient. Once the patient starts to get better, a standard ventilator can then support the patient’s breathing. This is something that our machine can’t do, so the patient needs to be transferred to a standard ventilator at this point.’

Short supply lines

The AIRone prototype was ready just three weeks after the kick-off meeting. All sorts of alterations have been made. The initially planned volume of production was 500 ventilators, but because the intensive care unit admissions in the Netherlands have dropped sharply, the number has been adjusted to 80 in consultation with the Ministry of Health, Welfare and Sport (VWS). "What is very important here: the parts needed to build the AIRone come from our own country, which guarantees the production chain. The fact that not all parts are immediately available is an important bottleneck for manufacturers of the standard respiratory equipment, "emphasizes Harlaar. "OperationAIR has also prepared for the implementation, service and further development phase. And a training plan has been developed with which training can be given to the healthcare staff. "

Open source

During that production a lot of experience is gained and our team is optimally prepared to expand the production if shortages arise in the Netherlands. We also share our experience and expertise abroad, making possible that the AIRone can be used in other countries. The design and documentation are available in open source at https://osf.io/mn7xq/ .

Brilliant ideas

Peter Somhorst is a medical engineer at the Erasmus MC. Having put the ventilator through its paces, he came to the conclusion that the students from Delft had delivered a top-class performance. ‘They developed an outstanding piece of equipment at lightning speed. And they did so without any experience or knowledge and without the funding available to manufacturers. Hats off to them.’ Although it is unclear whether the ventilator will actually be produced for Covid-19 patients being treated in the Netherlands, demand from other countries is likely to explode. Professor Harlaar: ‘We will be publishing our design as open-source data, so that hospitals in other countries can make good use of our expertise. We hope that this will help to remedy the worldwide shortage of ventilators.’ Professor Harlaar is full of praise for his students: ‘Everyone has worked exceptionally hard to get the project off the ground. It was a period of very hard work – and of some brilliant ideas. Like everyone else, I’m looking forward to the end of this terrible crisis. At the same time, I hope that we can build on the momentum generated by this project in our degree courses in clinical technology and technical medicine.’