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This 2017 Clinical Research Forum Distinguished Clinical Research Achievement Awards-winning study, led by Dr. Bhakti Patel from the University of Chicago, found that the use of a helmet for treatment of patients with ARDS reduced the need for ventilator use compared to the use of the standard face mask, and also prevented one death out of every five patients.

This video shows the process of setting up, fitting and removing a CaStar hood. Always refer to the Instructions for Use provided with each product and this video is not intended to replace them. The StarMed CaStar CPAP Hood for CPAP therapy is a comfortable, versatile and lightweight CPAP patient interface, designed to offer an alternative to traditional methods of CPAP delivery. The hood is well tolerated for extended periods and can reduce the risks associated with both endotracheal intubation and face mask use. Please visit directly the manufacturer's website for further information or to make an enquiry: https://www.intersurgical.com/products/critical-care/starmed-castar-hood-for-cpap-therapy

This video illustrates the equipment and demonstrates how it is assembled and applied with descriptions of initial ventilator settings. In a 2016 single-center randomized trial, noninvasive ventilation (NIV) delivered by helmet significantly reduced the intubation rate among patients with ARDS compared with the patients receiving NIV by face mask. Learn more: https://ja.ma/38R3xbJ.

Non-invasive ventilation using helmets is a patient treatment protocol used at intensive units and hospitals around the world to a different degree. The only USA manufacturer can not keep up with the demand. We all racing with time to #FlattenTheCurve and increase capacities of heathcare infrastructures, while borders are closing between even friendly countries, governments are restricting export activities and many DYI do-it-yourself innitiatives are picking up as we all need to act now and be #FasterThanVirus. Connect us with manufacturers worldwide Please connect us with manufacturers worldwide - share a contact via form https://mttd.wufoo.com/forms/p1a8jhb015g2ty6/ Or, even better, call them, ask a few questions (see the next survey below), ask them to fill-in or do it on their behalf. Please provide manufacturer’s info about products and capacities via form Please also indicate, if you (the manufacturer) give us consent to share publicly your information so that hospitals could order directly. https://mttd.wufoo.com/forms/x5trdac16cg2rd/ We are also consolidating, analysing and searching for solutions to resolve resource, capacity, funding shortages or other bottlenecks. We are working 24/7 to build up relevant, highly-sprecialized quality content, and contribute to containing the COVID-19 outbreak. Come back to our site, refer it to your network, who might benefit from this information, subscribe to our newsletter. #Ventilator #NIV #ICU #BiPAP #CPAP #LungVentilation #Helmet #BubbleHelmet

Do you have first-hand knowledge of using a helmet for noninvasive lung ventilation? Please help by answering these 4 questions through: the survey link below or by recording a brief audio/video on your smartphone and email to us at helmetventilator@gmail.com. Our team will transcribe. Thank you for your precious time and saving lines at the frontline of the COVI-19 pandemic. ​ Share your key 4 learnings at the ICU frontline: Do you use a helmet connected to airflow only (150-200 L/min), no ventilator or other breathing machines? If yes, would you recommend it? What are the positive effects of noninvasive ventilation via helmet for COVID-19 patients in your hospital? Does helmet use help you to save/open ICU beds for sickest COVID-19 patients? Can you say that a helmet use helps to minimize the spread of the COVID-19 virus due to filters in the system? ​ Survey Link >>>  https://mttd.wufoo.com/forms/pv1ekoz1o21wu6/ ​ This survey is being conducted by Aurika Savickaite, RN, MSN, who managed patients with noninvasive mechanical ventilation via helmet and worked closely with the research team at the University of Chicago Hospital. ​ The aim is to collect and consolidate in a single place the newest field-based information from the clinicians, who are or were managing respiratory distress in COVID-19 patients through the use of a helmet for noninvasive lung ventilation. ​ Survey Link >>>  https://mttd.wufoo.com/forms/pv1ekoz1o21wu6/

3/22/2020 As the number of people affected by COVID-18 grows, the Helmet-based ventilation website is focused on providing information and resources for helmet use for noninvasive ventilation in patients who have respiratory distress as a complication of the virus. With medical equipment manufacturers overwhelmed with meeting demands, efforts are being made to reach out to companies who have not previously been engaged in the production of these helmets, including implementing its Emergency Use Authorization process. "efforts are being made to reach out to companies who have not previously been engaged in the production of these helmets" On that end, the US Food and Drug Administration and Health and Human Services are trying to increase the availability of products to help support patients with significant breathing issues, according to a statement from Alex Azar, Health and Human Services Secretary. Wherever possible, health care facilities should use FDA-cleared conventional/standard full-featured ventilators to treat patients. With the current demand of helmet-based ventilation devices, the FDA is interested in connecting with manufacturers of ventilatory support devices not currently legally marketed in the U.S. Additionally, the FDA would like to connect with manufacturers who have not previously been engaged in medical device manufacturing – like auto manufacturers -- but could potentially have capabilities to increase the supply of these devices, according to information provided by the FDA. The FDA will work with these manufacturers through its EUA process, and interested manufacturers can contact the FDA at CDRH-COVID19-Ventilators@fda.hhs.gov. These changes will allow manufacturers and suppliers to adjust their production, equipment, and materials to be able to provide ventilators and increase supplies. Automakers like General Motors and Tesla – whose production lines were temporarily shut down -- will be able to repurpose production lines to manufacture ventilators. The agencies believe the best way to expand production of the needed ventilators is to work with companies willing to revamp and repurpose machines to ramp up production as quickly as possible. There are several key steps to promote the acceleration of production: The guidance describes the agency’s intention to exercise enforcement discretion for certain modifications to these FDA-cleared devices. Typically, approval of any changes can eat up valuable – possibly life-altering – time that it takes to get products to patients. This change will allow non-medical production sites – like the automobile plants – to start making ventilator parts. The FDA is being more lenient in lieu of the current pandemic situation, by not enforcing the premarket review requirement for these types of modifications. Another asset is the allowance of ventilators used for short-term use in ambulances to be repurposed in hospitals. The new guidelines also would allow ventilators at health care facilities to be used beyond their indicated shelf life. As a final measure, the FDC encourages foreign and domestic manufacturers to reach out to the FDA about obtaining an emergency use authorization, allowing them to distribute their ventilators in the United States – including state-side manufacturers who have capabilities to increase production and supply. These efforts are evidence of the FDA’s recognition of the seriousness of the immediate need to step up the production of these life-saving devices. As the number of COVID-19 cases grow by the hour, the FDA is working around the clock to address and resolve the challenges. The FDA is continually updating its frequently asked questions from labs and test developers, providing information on alternative sources of reagents, extraction kits, swabs and more. Additionally, laboratories can call the toll-free line at 1-888-INFO-FDA, with any questions they may have about the Emergency Use Authorization process or getting supplies. The FDA also granted an Emergency Use Authorization to allow industrial-use ventilators to be used in health-care settings and to provide conservation strategies for gowns and masks to make them more readily available for use. Strategies also are being developed for the use of surgical gloves, including extending the shelf life where there is low risk of virus transmission. For more information, click here for the full release from the U.S. Food and Drug Administration.

Italian medical staff prioritize helmets rather than face masks when providing noninvasive ventilation to hospital COVID-19 patients in intensive care units (ICU). An ER nurse who works in Italy also was surprised to learn that helmets are not being used in the US. Staff assumed helmet use was as widespread in the United States as it is in Italy, Valerio Korrado said to Aurika Savickaite via chat. Noninvasive ventilation (NIV) via helmet was tested successfully in a three-year study at the University of Chicago Medical Center. Researchers found helmets were more effective than face masks for patients with acute respiratory distress. Patients using helmets were less likely to be intubated, had fewer days in the ICU and hospital, and had a lower mortality rate. Valerio Korrado, a nurse and triage-nurse in the ER at Ospedale Civile Santo Spirito of Pscara, said hospital staff is using NIV via helmet for COVID-19 patients with mild dyspnea in ICUs, but in the ER they use full-face masks due to an equipment shortage. “Our recommendations say that the first choice for NIV should be helmets,” Korrado said because there is less risk for operators. The national guidelines of SIAARTI (Italian Society of Anesthesia and Intensive Care) advise using a helmet rather than face mask in the ICU for COVID-19 patients who are not intubated, Korrado said. Helmets can create a closed system to limit the possibility of contaminating others, especially when they are used with an antiviral/antibacterial filter. “During specific clinical conditions of the patient, we totally agree about considering this kind of treatment the best practice among the other NIV methods (face or full face) that many times create discomfort and complications, even to the operator that can be easily contaminated,” Korrado said. Korrado added that the helmets usually are connected to a mechanical ventilator, although they can be connected to wall gas. Helmets can be used without mechanical ventilation as an alternative for some patients and provide the same benefits as a CPAP machine would do if ventilators are in short supply. Watch our video to learn how to connect a helmet to wall gases.

Health care providers at a hospital in Italy pause each day at 1 p.m. to call families of their patients who have COVID-19. According to a Reuters article, the noon-hour used to be visiting hours for family, but not anymore. Patients who are hospitalized are isolated from family due to restrictions in place to stop the spread of the virus. Whenever a patient with coronavirus is accepted into his hospital, he says, the staff write an email to their relatives assuring them that their loved ones will be treated “like family.” He says the hospital is trying to activate a system of video-conferencing, so that patients can see their relatives during the 1 p.m. call. Marco Resta, deputy head of Policlinico San Donato’s Intensive Care Unit, said 50% of patients admitted to ICUs in Italy are dying. Hospitals are accepting only patients who need life-saving ventilation. Maurizio Cecconi, MD, head of Anesthesia and Intensive Care at Humanitas Research Hospital in Milan, said in an interview with JAMA Editor Howard Bauchner that his hospital triages patients to determine those who can be sent home and those who need an ICU bed. He said they make no distinction between people who need an ICU bed for COVID-19 or for other reasons, such as organ failure or trauma. Patients who are elderly and with underlying conditions are more at risk for complications of COVID-19, according to the CDC. They are more likely to be hospitalized in intensive care to receive ventilation help breathing. Noninvasive ventilation via helmet is an alternative solution for patients who can tolerate it. Studies have shown NIV via helmet reduces the rate of intubation among patients who get better faster and have a lower mortality rate. However, until the spread is halted, it’s unclear how families will be able to see their loved ones who are hospitalized, particularly those who are sedated for mechanical ventilation.

News reports have shown that COVID-19 patients in Italian hospitals are using helmets with ventilation to help them breathe. Helmets are an alternative to traditional noninvasive ventilation (NIV), which usually is provided via a mask to patients. Italy and other European countries have been using helmets more frequently to treat patients with acute respiratory distress syndrome (ARDS), even before the COVID-19 pandemic took hold. NIV via helmet is an option to treat patients as another step before intubation, which can cause additional health problems and is costly. Helmet-based ventilation was found to be more effective than ventilation via face mask in a three-year study at the University of Chicago Medical Center. The same study found patients improved faster, had fewer days in the ICU and hospital, and had a lower mortality rate. Helmets are being used in Italy now to treat COVID-19 patients who are in respiratory distress from the virus. Some reports refer to them as “bubble helmets,” since they are clear plastic and cover a patient’s head. The helmets provide air and oxygen flow to keep the lungs open and improve breathing in patients. Helmets can be safer for staff and patients with COVID-19 if they are used with an antiviral filter to keep the virus from leaving the helmet’s closed system. See the the video here

A ventilator can be rigged to serve two or four patients with COVID-19! A Canadian doctor has rigged a ventilator to double the number of patients he can serve at his rural hospital. Dr. Alain Gauthier, an anesthetist at the Perth and Smith Falls District Hospital in Ontario, got the idea from a YouTube video by Charlene Babcock, an emergency physician in Michigan, CBC News reported. Babcock created the how-to video to help doctors around the world respond to COVID-19. She shows how to hook up equipment and explains how it could be used for patients who have similar lung capacities. Babcock shows how a single ventilator could be used for two or four patients at a time. In the video, Babcock explains this technique hasn’t been studied, but it has been used in practice, following the 2017 mass shootings at a music festival in Las Vegas. There is a risk for cross-contamination, Babcock said in the video, but if it is used for COVID-19 patients, they would have the same infection. Gauthier told the press it’s not perfect, but “if it comes to last resort, I'm prepared to use it." His hospital serves an older population, many with underlying health conditions. Older adults and people of any age who have serious underlying medical conditions may be at higher risk for more serious complications from COVID-19, according to the CDC. Helmet-based ventilation is another alternative doctors can use to help patients in respiratory distress from COVID-19. While it’s not FDA approved nor used on a regular basis in ICUs, noninvasive ventilation via helmet is another option to try. Helmets also can be used without a ventilator when they are hooked up to wall oxygen. This is a viable solution for about 20% of patients. A shortage of ventilators is hampering clinicians and hospitals around the world as they care for patients with coronavirus, and according to the New York Times there is no way to solve the problem before it becomes a crisis. A Daily Mail article "Canadian doctor turns one ventilator into nine with some 'evil genius' DIY mechanics - winning fans, including Elon Musk" about Gauthier is misleading, stating he could connect nine patients to one ventilator. Original reports say he doubled the number of patients he can serve by placing two patients on one ventilator. His hospital has four new ventilators and four older ones in reserve.

John P. Kress, MD As of April 2, 2020, this is the most reliable and comprehensive training video about the use of a Helmet connected to wall gases or to BiPAP V60. detailed assembly instructions for a helmet from Dr. Bhakti Patel, The University of Chicago Medical Center (UChicago Medicine). New Video link: https://www.helmetbasedventilation.com/post/protocols-guidelines-for-using-a-helmet-ventilation-niv-from-uchicago-medicine-4-2-2020 With some simple parts, a helmet can be set up to connect to airflow from the hospital wall oxygen or medical air wall outlet to help patients with COVID-19. A mechanical ventilator, or non-invasive positive pressure ventilation (NIPPV) (corrected by the editor 02/27) is not needed when the helmet is used in this fashion. The oxygen and medical air flowing into the helmet produces positive pressure to recruit alveoli. “Certainly many people won’t tolerate this” John P. Kress, MD said when he explained the process to Aurika Savickaite. Patients with more advanced in respiratory distress may need to go directly to mechanical ventilation. Dr. Kress is a professor of medicine, specializing in pulmonary medicine and critical care medicine. He is the director of the Medical Intensive Care Unit at the University of Chicago Medicine. “But the experience in Italy suggests that about 20% of people can be managed this way. If there is a shortage of ventilators, this could prove to be very useful”, he said. Using a helmet with wall oxygen/air could be the first step for caregivers to use with patients. A second step would be to connect a helmet to a mechanical ventilator or CPAP. (Based on what we know today about COVID-19 patients - we should not try to go from CPAP via helmet off the wall to a ventilator, instead, you have to act fast and intubate. If you have a ventilator you can hook it up to the helmet and set it to pressure support - but if it fails in 1-2 hours - intubate the patient. Update from Dr. Kress 03/27). The final step would be intubation. Dr. Kress explained the parts needed to connect a helmet to wall oxygen: Updated video 3/21/2020 The helmet looks like this. It has two connecting ports (see red arrows below): On one of the helmet ports, you connect a standard bacterial/virus filter (blue device below) in between the helmet and a PEEP valve to prevent virus spread. The PEEP valve is the black device below. On the other helmet port you make the following connections: One clear end “nipple connector” (nipple for oxygen tubing connection is at the end of the connector). Then two blue side “nipple connectors” (nipple for oxygen tubing connection is on the side of the connector). One blue connector is placed between the two nipple connectors (connects the smaller diameter part of the blue nipple [see red arrows above]) “It’s basically like Legos. You just connect one after another,” Dr. Kress said. “It literally would take you just a few minutes to hook everything up.” Here is the full setup. There is one missing piece—the bacterial/virus filter needs to be connected between the helmet and the PEEP valve (see red arrow in the picture below): Then, turn the gas flow from the three flow meters on the wall as high as they will go. “That’s an important message to people,” Kress said. Turn the air and gas flow as high as it will go. The meter will stop at 15 l/min (see flow meters below), but if you turn the meter knob as high as it will go, the flow will be more than that. “If you just bury the needle, so to speak, turn it up as high as it will go, you get way more than 15 liters per minute,” he said. If you turn the flow up as high as it will go, you get 40-50 liters per minute from each flow meter. This means if you have three flow meters connected (see above) you can get ~ 120-150 liters per minute of total flow. This is important because it is best to have ~100 liters per minute of the fresh gas flow in order to prevent CO2 rebreathing in the helmet. If all three meters are at maximal flow, the FiO2 is 73.67% (100% + 100% + 21%/3). If you turn the oxygen flow meters down a bit, you can reduce the FiO2 closer to 60%. If you need 100% FiO2, just substitute the medical airflow meter with a third oxygen flow meter. Helmet-based ventilation most often is used with a ventilator. This alternative use of noninvasive ventilation (NIV) via helmet is another way medical staff can help patients with COVID-19 while trying to keep ICU beds for those who are most ill.

NIV helmets solve lung ventilation shortage in ICU's here is how you can help. >>> Fill in Survey! Share your knowledge We want feedback from the frontline clinicians, who treated COVID-19, to consolidate and share tips and issues, as well as to consolidate info about NIV helmet makers, identify capacities, logistics, bottlenecks, funding needs etc. Connect us to practitioners and hospital decision-makers Please connect us to practitioners and hospital decision-makers - Share contact via form https://mttd.wufoo.com/forms/p1kozcc11oyqqby/ - and/or ask them to fill in brief questionnaire https://www.helmetbasedventilation.com/fill-in-survey. Connect us with manufacturers worldwide Please connect us with manufacturers worldwide - share a contact via form https://mttd.wufoo.com/forms/p1a8jhb015g2ty6/ Please provide manufacturer’s info about products and capacities via form https://mttd.wufoo.com/forms/x5trdac16cg2rd/ Join hackathon Join hackathon to help automate and augment this effort.