The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices.

Rich Branson, Jeffrey R Dichter, Henry Feldman, Asha Devereaux, David Dries, Joshua Benditt, Tanzib Hossain, Marya Ghazipura, Mary King, Marie Baldisseri, Michael D Christian, Guillermo Domingiuez-Cherit, Kiersten Henry, Anne Marie O Martland, Meredith Huffines, Doug Ornoff, Jason Persoff, Dario Rodriquez, Ryan C Maves, Niranjan Tex Kissoon, Lewis Rubinson

Journal: Chest 2021;159(2):634-652

PMID: 32971074

Abstract

BACKGROUND

Early in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident.

RESEARCH QUESTION

Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current US Strategic National Stockpile (SNS) ventilators employed during the pandemic, and finally, compare ordered ventilators' functionality based on COVID-19 patient needs.

STUDY DESIGN AND METHODS

Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data were assembled into tabular format, which formed the basis for analysis and future recommendations.

RESULTS

COVID-19 patients often develop severe hypoxemic acute respiratory failure and adult respiratory defense syndrome (ARDS), requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only approximately half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high-level support are still of significant value in caring for many patients.

INTERPRETATION

Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next-generation SNS ventilator updates offered.

Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Address: Department of Surgery, Division of Trauma & Critical Care, University of Cincinnati, Cincinnati, OH.; Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN. Electronic address: [email protected].; Harvard Medical School, Boston, MA.; Department of Pulmonary Medicine, Sharp Coronado Hospital, Coronado, CA.; Department of Surgery, HealthPartners Medical Group, Regions Hospital, and University of Minnesota, St. Paul, MN.; Respiratory Care Services and General Pulmonary Clinic, University of Washington, Seattle, WA.; Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY.; The Department of Epidemiology and Biostatistics, New York University Langone Health, New York, NY.; Pediatric Critical Care Medicine and PICU, Harborview Medical Center, University of Washington, Seattle, WA.; Critical Care Medicine and Neurocritical Care, University of Pittsburgh Medical Center, Pittsburgh, PA.; London's Air Ambulance, Barts NHS Health Trust, London, England.; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, and Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran," Mexico.; MedStar Montgomery Medical Center, Olney, MD.; Department of Critical Care & Pulmonary Medicine, Scripps Health, San Diego, CA.; University of Maryland Medical Center, Baltimore, MD.; Internal Medicine Residency Training Program, University of Colorado School of Medicine, Aurora, CO.; Division of Hospital Medicine, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO.; Airman Biosciences Division, Airman Systems Directorate, the Department of Surgery, University of Cincinnati, OH.; Department of Critical Care Medicine, Naval Medical Center, San Diego, CA; Uniformed Services University, Bethesda, MD.; Department of Pediatrics and Emergency Medicine and the Child and Family Research Institute, UBC & BC Children's Hospital, Vancouver, BC, Canada.; Morristown Medical Center, Atlantic Health System, NJ.
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