Most critically ill COVID-19 patients need breathing support. Intubation is the process of inserting a tube through the mouth and then into the airway. The tube is then connected to a ventilator, which pushes air into the lungs to deliver a breath to the patient.
Intubating a COVID-19 patient is dangerous for health care workers because it brings them close to a patient’s mouth, which is constantly shedding the virus. Patients sometimes exhale or cough as the tube is inserted.
Early data suggests front-line health care workers may have a higher incidence rate of COVID-19 than the general public. The World Health Organization said last month about 22,000 health care workers worldwide are believed to have been infected with COVID-19, but some organizations believe the actual numbers are much higher.
Dr. Grant Lynde, chair of the American Society of Anesthesiologists’s Committee on Quality Management and Departmental Administration, said additional research is necessary to determine the box’s effectiveness in comparison to other protective gear, such as N95 masks or face shields. Still, Lynde, who works in Emory’s medical school, and was not involved in the collaboration, said the box is an important innovation in the ongoing effort to protect health care providers.
Dr. Cinnamon Sullivan, an assistant professor of anesthesiology at Emory University School of Medicine, and her colleague Dr. Jeremy Collins, an associate professor of anesthesiology, demonstrate how the four-sided box can be used to perform procedures such as intubating a patient who needs to be placed on a ventilator, and create a protective barrier for health care workers. CONTRIBUTED BY EMORY
The teams made about 200 boxes. Dr. Cinnamon Sullivan, an assistant professor of anesthesiology at Emory University School of Medicine, said she first heard about an open box known as the “Aerosol Box,” developed by a doctor in Taiwan to reduce the risk of COVID-19 exposure, in March.
While she was intrigued by the concept, and thought the Taiwanese doctor was onto something, she and colleagues identified flaws in the design. It was bulky, heavy and not easy to carry. And a lack of coverings in the hand openings could put doctors and nurses at an even higher risk of getting sick by a spray of respiratory droplets potentially reaching their faces and infecting them with the coronavirus than with no box at all.
So in late March, Sullivan and her colleague Dr. Jeremy Collins, associate professor of anesthesiology and executive vice chair of anesthesia at Emory, started making changes to the design. They decided to add sleeves (protected hand openings), already used in the operating room over surgical gowns to keep conditions sterile, to create a barrier and help protect the health care workers. The first prototype was heavy and large. But they kept tweaking the design.
“We had a lot of nervous energy,” said Sullivan, who is also the director of Global Health Anesthesiology at Emory University Hospital, about working during the early days of the COVID-19 pandemic. “And I felt like I needed to do something more. I was having difficulty sleeping and I would call Jeremy and say meet at the hospital on Saturday and let’s work on this.”
Working with Georgia Tech, they made other changes, and designed the box to easily fold up and transport. Some circles cut from the boxes remain on a dusty, wooden table inside the Flowers Invention Studio on the Tech campus.
Emory University Hospital now has as many as 120 of the boxes, and Sullivan and Collins said they now use them routinely when intubating COVID-19 and suspected COVID-19 patients. And Emory doctors believe the boxes have broad possibilities and could also be used for intubating patients with other infectious diseases.
“The feedback I have gotten when I first started taking this into the ICUs is the staff was very happy to get an added barrier,” Collins said.
He acknowledged intubating a patient while using the box has taken some getting used to, and there are instances when it may not be ideal, such as intubating a patient with an unusually shaped jaw, because it may slightly restrict movement.
Sullivan and Collins posted about the box on a private “Anesthesiologist COVID-19” group on Facebook, and several doctors across the country have expressed interest.
Back at Georgia Tech, Kentez Craig, 23, said he’s happy to be part of a team that created something that can help front-line health care workers. Craig, an Atlanta native and mechanical engineering student, aspires to become a research and development shop designer.
“I think we were able to get a product that is reliable and that will hopefully save lives,” he said.
HOW THE BOX WORKS
The box, a clear, polycarbonate material device the size of a stove, allows medical workers to intubate a patient but still be shielded from any respiratory droplets that may infect the worker. There are two holes, one for each arm, for the worker to treat a patient. The device is collapsible, which the team wanted to do to make it easier to carry.