Dr Rajeev Chauhan with the RC machine (Express Photo)
A team led by Dr Rajeev Chauhan, assistant professor in the anesthesiology department, PGIMER and consisting engineers Akash Gaddamwar and Eshan Dhar from Gyrodrive Machineries has come up with a prototype for an affordable and automatic AMBU bag operating device, which could prove to be the need of the hour as India struggles to fortify its medical infrastructure amidst the COVID-19 pandemic.
“We have been working on it for over a year now so this was not a reaction to COVID-19, but just a genuine need that I had observed working as a neuroanesthesiologist in the trauma ward. We saw many people with head injuries, who could not afford a mechanic ventilator or we just did not have enough ventilators for them,” says Dr Chauhan, who decided to start working on the machine in 2018, after observing patients in his ward receiving concentrated oxygen through the manual AMBU bags being operated by their relatives and attendants. The automatic AMBU bag created by Chauhan and his team, has been patented in Dr Rajeev Chauhan’s name, and has been labelled the RC (Respiration Control) Device.
Benefits of the new RC device
Due to an acute shortage of ventilators, as well as exorbitant costs of ICU services with a ventilating machine, most patients, especially in government hospitals, often have to rely on the manually operated AMBU bags for artificial ventilation. These manual resuscitators or AMBU bags provide a short-term alternative especially to healthcare institutions in developing countries such as India, but can have harmful and dangerous effects. “Human error for one, can lead to over or under pumping of the bag, often leading to lung trauma. Furthermore, in infectious epidemics such as COVID-19, it becomes impossible to allow exposing an attendant to the patient while pumping away at the AMBU bag” explains Dr Chauhan.
The RC device will be operated by a motor which will automatically pump the AMBU bag at the required rate per minute. The device can be fixed to a regular adult AMBU bag and the rate of rhythmic pumping of air can be fixed between 12 to 20 pumps per minute, in accordance with the patient’s needs. This will help erase the chances of human error leading to over pumping and lung trauma, while also decreasing the footfall of attendants and caregivers in hospitals and decreasing the chances of exposure to potential infections, such as the coronavirus.
Furthermore, the makers guarantee that the device will cost an average of Rs 7,000 to Rs 8,750. “Even if you look at the uppermost limit for costs, the device will at most cost Rs 15,000. On the other hand, an average ventilator which is attached to an ICU bed costs Rs 10 lakh at least,” says Dr Chauhan. The doctor adds that though some people ultimately do require the traditional and expensive mechanical ventilator, many lives can be saved with the use of the AMBU bag.
Insufficient health infrastructure to tackle COVID -19
Though the country might have enough infrastructure to cater to the current burden of COVID 19 patients, researchers predict that if the number of infected individuals continues to grow at the projected rate, government hospitals will have far from enough infrastructure to provide adequate care. Research by Brookings Institution suggests that in the worst-case scenario, there will be at least 2.2 million COVID-19 patients in India by May 15 who will require between 110,00 to 220,00 ventilators. Though there is no exact estimation of the number of ventilators in India, the think tank calculates that in a best-case scenario, the country has around 57,000 ventilators.
“There is an acute shortage of ventilators anyway. There is a long list of people waiting for ventilators, which includes at least 20 people in PGI. Many lives are generally lost due to such infrastructural lacks. If the pandemic grows, the need for ventilators will be too crucial.” says Dr Chauhan, adding that affordable and easier to create models such as the RC device can fill the gap in our healthcare infrastructure and buy the country more time to tackle the crisis. “For the cost of one traditional ventilator, one can purchase 25 of these and cater to a larger population,” adds the doctor.
Director, PGIMER, Dr Jagat Ram, said, “PGIMER is very proud of Dr Chauhan and the Department of Anesthesia of PGIMER. I am sure this creation will be of much service during these times. It will hopefully be put into practice soon.”