Updated: Aug 22
Q: What is this website about, are you selling anything?
A: This is a non-commercial private citizen initiative to organize information and help health care professionals learn the benefits of noninvasive ventilation (NIV) via the helmet. We publish information about the manufacturers, inventors and funding sources to help them connect so they can speed up the production of working helmets.
Q: What would helmet-based ventilation concretely bring in the present COVID-19 crisis?
A: Noninvasive ventilation (NIV) via helmet reduces intubation. Also, helmets can be used without a ventilator and outside of the ICU, allowing ventilators and ICU beds to be used by the illest patients.
FAQ about buying helmets
Q: Can I buy one or a few helmets for personal use?
A: No, not only there are not enough for hospitals, but manufacturers in the US are not legally allowed to sell to non-licensed doctors.
Q: Is there a way individuals can buy these to donate to our local hospital?
A: If you want to help - you can collaborate with hospitals and share information about helmet based ventilation
Q: How much helmets cost in the US?
A: The price range for the helmet only is $125 - $200. Some companies sell helmet kits which include PEEP valve, filter, and other adapters.
FAQ about making helmets or helping with parts, logistics
Q: We are manufacturers where can I get the drawings?
A: This repository, provided by "COSMIC Medical", contains all the design files necessary to build a bubble helmet device capable of providing non-invasive positive pressure ventilation. Updated 07/20/2020
We are aware that the Sea-Long Medical Systems Inc. owner Christopher Austin mentioned in the interview to NBS that he want to share drawings, but as of yet we don't have information about it. You can signup to our email list, we will send an email as soon as we can guide you to how to get the drawings. Posted 04/2020
Q: Many people are building helmets and looking to see what has or has not worked for others.
A: You can find more information about helmet production and manufacturing on Facebook Public Group "NIV Helmet Manufacturing Project to Combat COVID-19". Some inventors are sharing designs and manufacturing tips for free.
FAQ for Medical Professionals
Q: Are helmets superior to face masks.
A: JAMA 2016 study showed a dramatic reduction in the intubation rate compared to face masks. Helmets were shown to be dramatically better than face masks in ARDS.
Q: Helmets are said to be more expensive than face masks. Is it true?
A: Yes. But it is more effective in preventing intubation than a face mask. Intubation is very expensive in comparison to a helmet. Price for helmet $150 in the US.
Q: Helmets have existed since 2003 but don’t seem to have met success among ICUs.
A: The FDA (Food and Drug Administration) has not approved the European device in the USA. However, helmets are used widely in Europe.
Q: Very often, tubes that are available in hospitals are not compatible with new devices.
A: This is a valid point. Respiratory therapists are a good resource for connecting tubes. Here is how you can set up the helmet to use without a ventilator, only with wall oxygen or BiPAP!
(Video link Updated 04/02/2020)
Q: Which countries are using helmets for NIV?
A: Europe - Lithuania, Germany, England, and especially Italy.
Q: Medical staff feels uncomfortable by using this new device.
A: This can be learned fast and it’s not a new practice. If the physician or/and his critical care team can’t figure it out - don’t use it. In the USA we will be connecting two patients to one ventilator very soon - this practice is not used on a regular basis. The helmet is one more resort that we have to prepare to use. We, clinicians and hospital leaders, have to act faster than the government to stop COVID-19.
Q: If you have a patient on just oxygen/airflow with a helmet setup, what’s the difference between that and CPAP?
A: Nothing. It is a CPAP helmet without a ventilator.
Q: Can you connect multiple patients on helmets to one ventilator?
A: Theoretically. But you’re better off using endotracheal tubes if it comes to that.
Q: The Engineers are wondering if - the 100% oxygen flow is too dangerous and if 100 L/min is a high amount of consumption?
A: 100% FiO2 can cause lung injury if used for a long time. That’s why the medical air is there.
Airflow 100 L/min is not too high - the helmet has a large volume. Update 04/02/20 - with 60 L/min flow you can achieve 8-10 of PEEP. With 110-150 L/min flow you can achieve 20-25 L/min of PEEP.
Q: What you need for the helmet to work?
A: You must have a reliable fresh gas flow. You can do that one of two ways: with a ventilator and the ventilator is set to pressure support. See the UofC study led by Dr. Bhakti Patel. Or you can do it with the fresh gas flow from off the wall. Update 04/02/20 See the video by Dr, Patel. Also, you can connect the helmet to BiPAP V60.
Q: What setting should I use if I connect the helmet to the ventilator?
A: The take-home message is - If you’re gonna use a ventilator, you have to hook it up with pressure support.
Q: What should you NOT do?
A: Don’t place patients on a ventilator and set it to CPAP with no pressure support. Because if you do that, you will rebreathe CO2, and that’s what Taccone’s study showed. Updated 05/11/20
Reference: Taccone P, Hess D, Caironi P, Bigatello LM. Continuous positive airway pressure delivered with a “helmet”: effects on carbon dioxide rebreathing. Crit Care Med 2004;32(10):2090-2096.
Q: Why you can NOT connect the helmet to the CPAP machine?
A: If the patient is on a CPAP machine, it will depend on how strong the patient is to move the fresh gas into the circuit. So if I’m on CPAP and I’m young and strong and I can draw big breaths in and out, I will generate a substantial amount of fresh gas flow. But if I’m not young and strong, or if I start to get weak because I’m working, wearing out, the rate of fresh gas flow into the helmet will fall off substantially. And that’s what Catani and his group showed. Reference: Principi T, Pantanetti S, Catani F, Elisei D, Gabbanelli V, Pelaia P, Leoni P. Noninvasive continuous positive airway pressure delivered by the helmet in hematological malignancy patients with hypoxemic acute respiratory failure. Intensive Care Med 2004;30:147-150.
Q: Can I transition the patient from the helmet connected to the gas flow to the ventilator pressure support if he starts to deteriorate?
A: Today, we have the limited resources about COVID-19 patients, but what we hear from the frontline is that many of these patients seem to just take a downhill turn without much of a heads up. I think we are probably better off not trying to go from Helmet CPAP off the wall to a ventilator. We have to intubate. In the first hour or two, you’re going to know if the patient tolerating it well or not. Based on feedback from Prof. Pesenti, is that the good news is if it’s working it’s pretty obvious. The bad news is if it isn’t working you need to act fast! Because if you futz around, you’ll be dealing with intubation while you’re doing CPR.
ADVICE from Prof. John P Kress: Keep it simple! “The setup that we have is much simpler because you don’t need a ventilator. If ventilators become limited, then that’s a nice feature. If noninvasive continuous positive airway pressure (nCPAP) delivered by the helmet without a ventilator isn’t working, the advice that I’m hearing from others, and I would give the same advice, is you just have to intubate.”
Q: Are there cleaning instructions for helmets? Is the helmet a single patient use?
A: Some hospitals have a process of sterilizing the helmets by using a hydrogen peroxide application, so it can be reused again. Helmets from different companies have different sterilization guidelines. For example, Amron International Hood can be sterilized or disinfected by means of autoclave, Gama, gas sterilization, and fast-acting germicidal disinfectants.
Just keep in mind that helmets with a customized collar can be used for someone who has a similar neck size. Also, the collar part for these helmets can be replaced.
Dr. Cereda from Penn Medicine shared the Sea-Long Helmet disinfection process document from his hospital. 05/28/2020