A breathing aid that can help keep COVID-19 patients out of intensive care – adapted by mechanical engineers at UCL and clinicians at UCLH working with Mercedes-AMG High Performance Powertrains – has been approved for use in Britain's NHS.

The breathing aid, known as Continuous Positive Airway Pressure (CPAP), has been used extensively in hospitals in Italy and China to help COVID-19 patients with serious lung infections to breathe more easily, when oxygen alone is insufficient.

Working round the clock at UCL’s engineering hub

Since Wednesday March 18, engineers at UCL and HPP and clinicians at UCLH have been working round the clock at UCL’s engineering hub MechSpace to reverse engineer a device that can be produced rapidly by the thousands. This has now been recommended for use by the UK Medicines and Healthcare products Regulatory Agency (MHRA).

This breathing aid was produced within a rapid timeframe – it took fewer than 100 hours from the initial meeting to production of the first device. One hundred devices are to be delivered to UCLH for clinical trials, with rapid roll-out to hospitals around the country ahead of the predicted surge in COVID-19 hospital admissions.

Providing vital technologies

The collaboration, supported by the National Institute for Health Research UCLH Biomedical Research Centre, demonstrates the way that universities, the NHS and industry are coming together to help the national response to the COVID-19 coronavirus outbreak, by providing vital technologies to the NHS which can enable them to care for patients who require respiratory support.

Reports from Italy indicate that approximately 50% of patients given CPAP have avoided the need for invasive mechanical ventilation. However, such devices are in short supply in UK hospitals.

UCLH critical care consultant Professor Mervyn Singer (UCL Medicine) said: “These devices will help to save lives by ensuring that ventilators, a limited resource, are used only for the most severely ill.  

Make a real difference to hospitals

“While they will be tested at UCLH first, we hope they will make a real difference to hospitals across the UK by reducing demand on intensive care staff and beds, as well as helping patients recover without the need for more invasive ventilation.”

Professor Rebecca Shipley, director of UCL Institute of Healthcare Engineering, said: 

“At UCL, we have an established ecosystem of partnerships spanning engineers, healthcare and industry ready to be mobilised in times of need. It’s been a privilege to work closely with our clinical colleagues and with doctors leading the Covid-19 response in China and Italy. This close contact has helped us to define the need and respond with technology that we hope will support the NHS in the weeks and months to come.”

Professor Tim Baker (UCL Mechanical Engineering) said: “Given the urgent need, we are thankful that we were able to reduce a process that could take years down to a matter of days.

“From being given the brief, we worked all hours of the day, disassembling and analysing an off-patent device. Using computer simulations, we improved the device further to create a state-of-the-art version suited to mass production.

Call on capability of Formula One

“We were privileged to be able to call on the capability of Formula One – a collaboration made possible by the close links between UCL Mechanical Engineering and HPP.”

Professor Michael Arthur, UCL president and provost, said: “I am very proud to see UCL in collaboration with industry and international partners make such a speedy and potentially life-saving contribution to the national interest at this time of unprecedented challenge for our country and so many others around the world."

Professor David Lomas, UCL vice-provost Health, said: “This breakthrough has the potential to save many lives and allow our frontline NHS staff to keep patients off ventilators. I would like to pay tribute to the incredible team of engineers and clinicians at UCL, HPP and UCLH, for working round the clock to develop this new prototype.

Regulator approval in just 10 days

"It is, quite simply, a wonderful achievement to have gone from first meeting to regulator approval in just 10 days. It shows what can be done when universities, industry and hospitals join forces for the national good.”

UCLH chief executive Marcel Levi said: “This is a real team effort and I am proud of colleagues at UCLH and our partners at UCL and HPP for their immense work to produce this device in such a short time. We hope this effort can be rolled out to hospitals across the UK to benefit all patients.

“Everyone involved in this project should know that their efforts will have a truly significant impact on patient care.”

Professor Bryan Williams, director of the NIHR Biomedical Research Centre at UCLH, said: “This is a fantastic example of collaboration across the UK life sciences and industry sector that could only have happened this quickly because of the partnerships the BRC has cultivated over many years.”

Andy Cowell, managing director of Mercedes-AMG High Performance Powertrains, said:

 “The Formula One community has shown an impressive response to the call for support, coming together in the ‘Project Pitlane’ collective to support the national need at this time across a number of different projects. We have been proud to put our resources at the service of UCL to deliver the CPAP project to the highest standards and in the fastest possible timeframe.”

Would normally take two years

Andy Obeid, chief executive of Oxford Optronix, a small business that will manufacture the oxygen monitors for the CPAP devices, said: “By working flat out and mobilising the support of every individual in my company as well as other small companies across the UK, we have accomplished something in five days that would normally take two years.

“I am delighted we have been able to design, develop, test and manufacture a bedside monitor that will continuously measure the concentration of oxygen being delivered to the patient and is ready for clinical trials.”

Phenomenal environment

Professor Yiannis Ventikos, head of UCL mechanical engineering, said: “MechSpace is where we teach our students how to design, build and test simple and complex machines using state-of-the-art equipment and methods. In this phenomenal environment, our engineers were well placed to act with speed and create critical equipment that our hospitals need.”

CPAP machines are routinely used by the NHS to support patients in hospital or at home with breathing difficulties. They work by pushing an air-oxygen mix into the mouth and nose at a continuous rate, keeping airways open and increasing the amount of oxygen entering the lungs. Invasive ventilators deliver breaths directly into the lungs, but require heavy sedation and connection to a tube placed into the patient’s trachea (windpipe).

(*‘Project Pitlane’ is a collective of UK-based Formula 1 teams and their respective technology arms coordinating a response to the UK government’s call for assistance with the manufacture of medical devices. It will pool the resources and capabilities of its member teams, focusing on the core skills of the F1 industry: rapid design, prototype manufacture, test and skilled assembly. F1’s ability to respond rapidly to engineering and technological challenges allows the group to add value to the wider engineering industry’s response.)

Separately, The Irish Times has reported that  a collaboration of engineers and specialists in medical devices are finalising the prototype of an emergency ventilator for use in treating critically-ill COVID-19 patients.

'Battlefield' ventilator development in Galway

They hope the 'battlefield' ventilator will help ease a likely surge in demand for these life-saving devices in Ireland, and be capable of being manufactured all over the world.

They are being supported by multinationals, including Boston Scientific, based in Galway – and by medical experts, notably anaesthetists who deploy the technology.

What began as a conversation between John Wallace and a fellow engineer on what they could do to help worldwide efforts to counter the COVID-19 pandemic, prompted a drawing and then an intensive two-week hackathon at the end of which a prototype design emerged.

That was completed recently by the COVID response team (CRT) of engineers, which had been based at the city’s Clarion hotel, he said.

An expanded team, relocated to the Boston Scientific campus, has been working almost round the clock to generate the first physical prototype. The project was advanced to the point where components were being built using 3D printing technology.

The group is networking with groups all over the world, Wallace added, trying to address an acute shortage of ventilators based on alarming WHO projections on likely cases.