As the coming storm of the COVID-19 pandemic loomed in the New York metropolitan region in early March, the faculty and staff of Stony Brook University Hospital (SBUH) started mobilizing to address the grim predictions of shortages of critical equipment needed to empower clinicians to save lives. In response to the crisis, a team of faculty, healthcare practitioners and clinicians from Stony Brook’s College of Engineering and Applied Sciences (CEAS), Renaissance School of Medicine (RSOM) and School of Health Technology and Management (SHTM) was rapidly assembled with the help and visionary leadership of New York State Assemblyman Steve Englebright. Using only readily available components, the team took on the daunting task of conceiving, designing, building and testing a ventilator that could be made available to SBUH and other clinicians when and if a critical shortage arose, thereby saving lives when the number of patients needing mechanical ventilation exceeded ventilator reserves.
Conceptualized, built, tested and refined over the course of 10 days, the CoreVent 2020 ventilator was designed for simplicity and ease of fabrication in a crisis situation. CoreVent 2020 uses readily available parts from multiple vendors and standard ventilator connections, intentionally made to be both flexible and broad in scope. In an example of engineering-driven medicine at its very best, the prototype was developed by a team of mechanical engineering faculty, clinicians in the Respiratory Care Program in SHTM and physicians from RSOM.
“In engineering we typically quantify the impact of research in terms of the H (or Hirch) Index, which measures how widely faculty publications are cited by peers. In this extraordinary moment of crisis, we had to quickly focus on the L Index, which would measure our impact by the number of lives we could help save,” said Fotis Sotiropoulos, Dean of CEAS. “Standing together with the heroic SBUH physicians and healthcare workers, our faculty worked day and night to design, build and test this ventilator in record time to support our clinicians as they fight to save lives.
The team was led by Jon Longtin, CEAS Associate Dean of Research and Entrepreneurship and professor of mechanical engineering. Longtin had already engaged in a number of other projects with the hospital, including a medical face shield. He and Dr. Christopher Page, MD, Acute Pain Division Chief in the Department of Anesthesiology at RSOM, had started speaking as soon as the crisis emerged about the possibility of building a ventilator that is “as simple as possible, but not simpler.” At the same time, Assemblyman Englebright contacted Dean Sotiropoulos with the idea of putting together a team that combined Stony Brook’s expertise in engineering and medicine to build a ventilator here on Long Island. He introduced John Brittelli, a clinical professor in the Respiratory Care Program in STHM and Dr. Brian Margolis, MD, pulmonary disease specialist at St. Catherine of Siena Medical Center, to the CEAS and RSOM team. Soon after, Dimitris Assanis, assistant professor of mechanical engineering, was also added to the team.
An aggressive timeline was developed and executed with the team working day and night to complete the design, prototype and testing in only 10 days to develop a functional, reliable ventilator that could be used satisfactorily should the existing reserve of ventilators be exhausted due to the COVID-19 pandemic.
The events unfolded in breathtaking speed as follows:
Sat., March 28: Assemblyman Englebright connects Brittelli and Margolis with Sotiropoulos and Longtin. An initial ventilator concept is developed. At a planning meeting in Englebright’s office with Sotiropoulos, Longtin, Brittelli and Margolis, the design is critically reviewed and the decision is made to move full speed ahead to develop the device as soon as possible.
Sun., March 29: Longtin engages Assanis to join the team. Longtin and Assanis build a preliminary prototype in Longtin’s Port Jefferson garage, using parts purchased from Home Depot.
Mon., March 30: The prototype is moved to Brittelli’s respiratory therapy teaching lab in RSOM for evaluation and testing. A pressure sensor is needed for the prototype ASAP. Sotiropoulos puts out a request to CEAS faculty for help. The response is overwhelming, with 40-50 people offering help, including faculty from other colleges, Brookhaven National Lab and the local community.
Tue., March 31: Dr. Gerald Smaldone, MD, Chief of Pulmonary Medicine at Stony Brook RSOM, and Michael McPeck, Research Support Specialist in the Pulmonary and Critical Care Medicine Division, view the prototype and provide helpful suggestions, guidance and testing recommendations to the team.
Wed., Apr. 1 – Fri., Apr. 3: Longtin, Brittelli and Assanis develop a second prototype using oxygen-compatible parts. Further testing and functionality are implemented. Assanis takes the lead to incorporate the prototype into a medical cart suitable for use in a hospital ICU unit.
Sat., Apr. 4: The opportunity to do testing on two live pigs is presented to the team. The ventilator performed well. Testing results are used to improve the device further.
Mon., Apr 6: The design is finalized. Testing and adjustments continue on the device.
The final result is the CoreVent 2020, a computer-controlled, pressure-cycled, time-limited ventilator that includes an assisted-breathing mode and the ability to apply positive, end-expiratory pressure, and uses no proprietary components. The device has low- and high-pressure alarm functions, and provides both visual system status indicators and a menu-based computer interface to control the ventilator.
“During this extraordinary time in medicine, it is vital that all corners of a research-oriented university be engaged to solve the myriad of problems facing healthcare professionals caring for our patients,” said Dr. Kenneth Kaushansky, MD, MACP, Senior Vice President for Health Sciences and Dean of RSOM. “The development of the CoreVent 2020 in so short a time illustrates that ‘what we do here, what we do now, will define us.’ And the merging of the talents of the faculty and staff of the three Schools defines Stony Brook very well indeed.”
Discussions are underway with Long Island-based company Biodex Medical Systems to manufacture the initial CoreVent 2020 units as the COVID-19 crisis dictates. The team has also engaged the appropriate regulatory agencies to explore pathways that will allow emergency use of the device at Stony Brook Hospital and other institutions as well.
— Chris Maio