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← The universal anesthesia machine

What if you're in surgery and the power goes out? No lights, no oxygen -- and your anesthesia stops flowing. It happens constantly in hospitals throughout the world, turning routine procedures into tragedies. Erica Frenkel demos one solution: the universal anesthesia machine.

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Showing Revision 3 created 11/09/2016 by Krystian Aparta.

  1. I'm going to talk to you today
  2. about the design of medical technology
    for low-resource settings.
  3. I study health systems in these countries.
  4. And one of the major gaps in care,
  5. almost across the board,
  6. is access to safe surgery.
  7. Now one of the major
    bottlenecks that we've found
  8. that's sort of preventing
    both the access in the first place,
  9. and the safety of those surgeries
    that do happen, is anesthesia.
  10. And actually, it's the model
    that we expect to work
  11. for delivering anesthesia
    in these environments.
  12. Here, we have a scene that you would find
    in any operating room across the US,

  13. or any other developed country.
  14. In the background there
  15. is a very sophisticated
    anesthesia machine.
  16. And this machine is able
    to enable surgery and save lives
  17. because it was designed
    with this environment in mind.
  18. In order to operate,
    this machine needs a number of things
  19. that this hospital has to offer.
  20. It needs an extremely
    well-trained anesthesiologist
  21. with years of training
    with complex machines
  22. to help her monitor the flows of the gas
  23. and keep her patients
    safe and anesthetized
  24. throughout the surgery.
  25. It's a delicate machine
    running on computer algorithms,
  26. and it needs special care, TLC,
    to keep it up and running,
  27. and it's going to break pretty easily.
  28. And when it does, it needs
    a team of biomedical engineers
  29. who understand its complexities,
    can fix it, can source the parts
  30. and keep it saving lives.
  31. It's a pretty expensive machine.

  32. It needs a hospital
    whose budget can allow it
  33. to support one machine
    costing upwards of 50 or $100,000.
  34. And perhaps most obviously,
  35. but also most importantly --
  36. and the path to concepts
    that we've heard about
  37. kind of illustrates this --
  38. it needs infrastructure that can supply
    an uninterrupted source of electricity,
  39. of compressed oxygen,
    and other medical supplies
  40. that are so critical
    to the functioning of this machine.
  41. In other words, this machine
    requires a lot of stuff
  42. that this hospital cannot offer.
  43. This is the electrical supply
    for a hospital in rural Malawi.

  44. In this hospital,
  45. there is one person qualified
    to deliver anesthesia,
  46. and she's qualified
  47. because she has 12, maybe 18 months
    of training in anesthesia.
  48. In the hospital and in the entire region
  49. there's not a single biomedical engineer.
  50. So when this machine breaks,
  51. the machines that they have
    to work with break,
  52. they've got to try and figure it out,
  53. but most of the time,
    that's the end of the road.
  54. Those machines go the proverbial junkyard.
  55. And the price tag
    of the machine that I mentioned
  56. could represent maybe a quarter or a third
  57. of the annual operating budget
    for this hospital.
  58. And finally, I think you can see
    that infrastructure is not very strong.

  59. This hospital is connected
    to a very weak power grid,
  60. one that goes down frequently.
  61. So it runs frequently,
    the entire hospital,
  62. just on a generator.
  63. And you can imagine,
    the generator breaks down
  64. or runs out of fuel.
  65. And the World Bank sees this
  66. and estimates that a hospital
    in this setting in a low-income country
  67. can expect up to
    18 power outages per month.
  68. Similarly, compressed oxygen
    and other medical supplies
  69. are really a luxury,
  70. and can often be out of stock
    for months or even a year.
  71. So it seems crazy, but the model
    that we have right now

  72. is taking those machines
    that were designed
  73. for that first environment
    that I showed you
  74. and donating or selling them
    to hospitals in this environment.
  75. It's not just inappropriate,
  76. it becomes really unsafe.
  77. One of our partners at Johns Hopkins

  78. was observing surgeries in Sierra Leone
    about a year ago.
  79. And the first surgery of the day
    happened to be an obstetrical case.
  80. A woman came in,
    she needed an emergency C-section
  81. to save her life and the life of her baby.
  82. And everything began pretty auspiciously.
  83. The surgeon was on call and scrubbed in.
  84. The nurse was there.
  85. She was able to anesthetize her quickly,
    and it was important
  86. because of the emergency
    nature of the situation.
  87. And everything began well
  88. until the power went out.
  89. And now in the middle of this surgery,
  90. the surgeon is racing
    against the clock to finish his case,
  91. which he can do -- he's got a headlamp.
  92. But the nurse is literally running
    around a darkened operating theater
  93. trying to find anything
    she can use to anesthetize her patient,
  94. to keep her patient asleep.
  95. Because her machine doesn't work
    when there's no power.
  96. This routine surgery that many of you
    have probably experienced,
  97. and others are probably the product of,
    has now become a tragedy.
  98. And what's so frustrating
    is this is not a singular event;
  99. this happens across the developing world.
  100. 35 million surgeries
    are attempted every year
  101. without safe anesthesia.
  102. My colleague, Dr. Paul Fenton,
    was living this reality.

  103. He was the chief of anesthesiology
  104. in a hospital in Malawi,
    a teaching hospital.
  105. He went to work every day
  106. in an operating theater like this one,
  107. trying to deliver anesthesia
    and teach others how to do so
  108. using that same equipment
  109. that became so unreliable,
    and frankly unsafe, in his hospital.
  110. And after umpteen surgeries
  111. and, you can imagine,
    really unspeakable tragedy,
  112. he just said, "That's it.
    I'm done. That's enough.
  113. There has to be something better."
  114. He took a walk down the hall
  115. to where they threw all those machines
    that had just crapped out on them,
  116. I think that's the scientific term,
  117. and he started tinkering.
  118. He took one part from here
    and another from there,
  119. and he tried to come up
    with a machine that would work
  120. in the reality that he was facing.
  121. And what he came up with:

  122. was this guy.
  123. The prototype for the Universal
    Anesthesia Machine --
  124. a machine that would work
    and anesthetize his patients
  125. no matter the circumstances
    that his hospital had to offer.
  126. Here it is, back at home
  127. at that same hospital, developed
    a little further, 12 years later,
  128. working on patients
    from pediatrics to geriatrics.
  129. Let me show you a little bit
    about how this machine works.

  130. Voila!
  131. Here she is.
  132. When you have electricity,
  133. everything in this machine
    begins in the base.
  134. There's a built-in
    oxygen concentrator down there.
  135. Now you've heard me mention
    oxygen a few times at this point.
  136. Essentially, to deliver anesthesia,
    you want as pure oxygen as possible,
  137. because eventually you're going
    to dilute it, essentially, with the gas.
  138. And the mixture that the patient inhales
  139. needs to be at least
    a certain percentage oxygen
  140. or else it can become dangerous.
  141. But so in here when there's electricity,
  142. the oxygen concentrator takes in room air.
  143. Now we know room air is gloriously free,
  144. it is abundant,
  145. and it's already 21 percent oxygen.
  146. So all this concentrator does
    is take that room air in, filter it
  147. and send 95 percent pure oxygen
    up and across here,
  148. where it mixes with the anesthetic agent.
  149. Now before that mixture
    hits the patient's lungs,

  150. it's going to pass by here --
    you can't see it,
  151. but there's an oxygen sensor here --
  152. that's going to read out on this screen
    the percentage of oxygen being delivered.
  153. Now if you don't have power,
  154. or, God forbid, the power cuts out
    in the middle of a surgery,
  155. this machine transitions automatically,
  156. without even having to touch it,
  157. to drawing in room air from this inlet.
  158. Everything else is the same.

  159. The only difference is that now
  160. you're only working
    with 21 percent oxygen.
  161. Now that used to be
    a dangerous guessing game,
  162. because you only knew
    if you gave too little oxygen
  163. once something bad happened.
  164. But we've put a long-life
    battery backup on here.
  165. This is the only part
    that's battery backed up.
  166. But this gives control to the provider,
    whether there's power or not,
  167. because they can adjust the flows
  168. based on the percentage of oxygen
    they see that they're giving the patient.
  169. In both cases,
    whether you have power or not,

  170. sometimes the patient
    needs help breathing.
  171. It's just a reality of anesthesia,
    the lungs can be paralyzed.
  172. And so we've just added
    this manual bellows.
  173. We've seen surgeries
    for three or four hours
  174. to ventilate the patient on this.
  175. So it's a straightforward machine.

  176. I shudder to say simple;
    it's straightforward.
  177. And it's by design.
  178. You do not need to be a highly trained,
    specialized anesthesiologist
  179. to use this machine,
  180. which is good because,
    in these rural district hospitals,
  181. you're not going to get
    that level of training.
  182. It's also designed for the environment
    that it will be used in.
  183. This is an incredibly rugged machine.

  184. It has to stand up to the heat
    and the wear and tear
  185. that happens in hospitals
    in these rural districts.
  186. And so it's not going
    to break very easily,
  187. but if it does, virtually
    every piece in this machine
  188. can be swapped out and replaced
  189. with a hex wrench and a screwdriver.
  190. And finally, it's affordable.
  191. This machine comes in
    at an eighth of the cost
  192. of the conventional machine
    that I showed you earlier.
  193. So in other words, what we have here
    is a machine that can enable surgery
  194. and save lives,
  195. because it was designed
    for its environment,
  196. just like the first machine I showed you.
  197. But we're not content to stop there.

  198. Is it working?
  199. Is this the design
    that's going to work in place?
  200. Well, we've seen good results so far.
  201. This is in 13 hospitals in four countries,
  202. and since 2010, we've done
    well over 2,000 surgeries
  203. with no clinically adverse events.
  204. So we're thrilled.
  205. This really seems like
    a cost-effective, scalable solution
  206. to a problem that's really pervasive.
  207. But we still want to be sure
  208. that this is the most effective
    and safe device
  209. that we can be putting into hospitals.
  210. So to do that, we've launched
    a number of partnerships

  211. with NGOs and universities,
  212. to gather data on the user interface,
  213. on the types of surgeries
    it's appropriate for,
  214. and ways we can enhance the device itself.
  215. One of those partnerships
    is with Johns Hopkins
  216. just here in Baltimore.
  217. They have a really cool anesthesia
    simulation lab out in Baltimore.
  218. So we're taking this machine
  219. and recreating some
    of the operating theater crises
  220. that this machine might face
  221. in one of the hospitals
    that it's intended for,
  222. and in a contained, safe environment,
  223. evaluating its effectiveness.
  224. We're then able to compare
    the results from that study
  225. with real-world experience,
  226. because we're putting
    two of these in hospitals
  227. that Johns Hopkins
    works with in Sierra Leone,
  228. including the hospital
    where that emergency C-section happened.
  229. So I've talked a lot about anesthesia,
    and I tend to do that.

  230. I think it is incredibly fascinating
    and an important component of health.
  231. And it really seems peripheral,
    we never think about it,
  232. until we don't have access to it,
  233. and then it becomes a gatekeeper.
  234. Who gets surgery and who doesn't?
  235. Who gets safe surgery and who doesn't?
  236. But you know,
    it's just one of so many ways
  237. that design, appropriate design,
  238. can have an impact on health outcomes.
  239. If more people
    in the health-delivery space
  240. really working on some of these
    challenges in low-income countries
  241. could start their design process,
    their solution search,
  242. from outside of that proverbial box
  243. and inside of the hospital --
  244. In other words, if we could design
  245. for the environment that exists
    in so many parts of the world,
  246. rather than the one
    that we wished existed --
  247. we might just save a lot of lives.
  248. Thank you very much.

  249. (Applause)