4/15/2020 Chicago
A physician familiar with the helmet-based ventilation system is an advocate for their use in treating COVID-19 in the United States. Dr. Maurizio Franco Cereda of the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center has a history with the use of the helmets. His credentials include Associate Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania, among others. Cereda also practiced in Monza, near Milan prior to coming to the United States in 1999.
Cereda said helmet-based ventilation has been used in Italy since before 1990, where it has since gained considerable popularity – and success. The same could not be said when the concept was first suggested in the United States. “Every time I talked about the helmet in the U.S., they always looked at me as a weird animal,” he said with a gentle laugh. Cereda considered doing different studies but didn’t have the support needed.
With the “arrival” of COVID-19, Cereda discussed the prospect with his partners – and this time was met with more enthusiasm.
Now, Cereda is introducing the helmets slowly throughout his hospital to ensure the process is being done correctly.
“I think they averted intubation in at least three patients who are fine now,” Cereda said in an interview with Aurika Savickaite, cofounder of the Helmet-Based Ventilation website.
Cereda and his staff are training other medical staff, he said.
“The goal is to be able to deploy a massive amount of helmets as they do in Italy,” Cereda said.
During its recent COVID-19 outbreak, the Monza hospital Cereda was affiliated with experienced notable success with the helmets. About 200 patients were simultaneously treated via helmet-based ventilation, compared to 50 to 60 intubated patients.
“I am very familiar with (the helmet) and the system here has to get used to it,” Cereda said. “It’s new; people feel uncomfortable seeing something that is so different.”
But as soon as the results are realized, those involved – from patients to physicians – are more receptive.
“Everybody’s happy,” Cereda said. “I think it’s going to go well here.”
Savickaite agreed. Invasion ventilation and intubation were the common treatment, she said but cited the high mortality rate usually associated with that method.
“This is why I was thinking non-invasive ventilation is the answer right now,” Savickaite said. “If we can keep these patients oxygenated for a longer time on a helmet, we may see 20, 30 percent of patients on the helmet may avoid intubation.
“That’s a pretty good number,” she said.
Another goal is to have a CPAP-advanced respiratory care floor, caring for patients too sick to be on a regular floor, but whose care can be managed by other non-invasive methods, including the helmet, Cereda said.
“That’s a great plan,” Savickaite said. “You need those helmet champions in your hospital that can deliver success.”
Those successes are fueled by other attributes of the helmet-based ventilation system.
“People feel safer not using high (oxygen) flows, and the helmet is a blessing for them,” he said.
The method also affords protection for staff, as the helmets are self-contained, and can protect the staff from any respiratory spread.
My goal is to have a system that can be used without any device or machine,” he said. “I want it to be as simple as possible.”
Helmet use can also be used in crucial times when a patient is waiting for a ventilator – when the minutes – or hours – without any respiratory treatment could be a death sentence, Cereda said.
“You want to have a way to bridge your patients, even if you know you’re going to have to intubate, you may not be able to intubate when you want to intubate – just because you don’t have an ICU bed, you don’t have a ventilator,” he said. “So instead of letting them die, while waiting, put them on the helmet, (and) you buy six, seven hours.”
Savickaite agreed, citing her previous experience as a patient care manager in the MICU at the University of Chicago Hospital.
“I see the big picture … these patients have to wait sometimes for the ICU room to get open and get that ventilator,” she said.
Respiratory therapists – and patients – like the idea of the helmet, he said, referring to feedback after a demonstration at his hospital. “It was instant,” he said. “They saw the patient wasn’t choking himself and was happy, and the therapists were very happy.”
There also is a degree of comfort for the medical staff – especially respiratory therapists, who are at the highest risk of contact, touching the patient, the ventilator and doing the suctioning. “The therapists know they are the most exposed people in the chain,” Cereda said.
The self-enclosed helmet protects staff from contact.
“I think it’s psychological; they feel they are protected,” Cereda said. “(When they see) someone cares about them, their mood is different.
“I believe the way you show leadership is by showing that you care and that you care about your troops because this is like war,” he said. “So, if the troops know that the captain cares about them it’s a totally different mood in the unit.
“And I think the helmets have been helping,” he said.
In this mass scale disaster situation, the helmet can be a lifesaver – and it is hoped it can continue to make an impact post-COVID-19. As the need continues, so does the tweaking of the helmet – including a soft collar to not only make it more comfortable – but to increase production capabilities.
“We’re putting a foot in the door … the hospitals and clinicians will be asking for it, when they see the benefit of it,” Savickaite said. “You will need less money, you can produce it faster, you can deliver it faster… this simple device.”
About Maurizio Franco Cereda, MD:
Associate Professor of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania
Attending Anesthesiologist, Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center
Co-Director, Surgical Intensive Care Unit
Program Director, Adult Critical Care Medicine Fellowship
Department: Anesthesiology and Critical Care