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Review
. 2021 Feb;159(2):634-652.
doi: 10.1016/j.chest.2020.09.085. Epub 2020 Sep 21.

The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices

Rich Branson  1 , Jeffrey R Dichter  2 , Henry Feldman  3 , Asha Devereaux  4 , David Dries  5 , Joshua Benditt  6 , Tanzib Hossain  7 , Marya Ghazipura  8 , Mary King  9 , Marie Baldisseri  10 , Michael D Christian  11 , Guillermo Domingiuez-Cherit  12 , Kiersten Henry  13 , Anne Marie O Martland  14 , Meredith Huffines  15 , Doug Ornoff  16 , Jason Persoff  17 , Dario Rodriquez Jr  18 , Ryan C Maves  19 , Niranjan Tex Kissoon  20 , Lewis Rubinson  21
Affiliations
Review

The US Strategic National Stockpile Ventilators in Coronavirus Disease 2019: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices

Rich Branson et al. Chest. 2021 Feb.

Abstract

Background: Early in the coronavirus disease 2019 (COVID-19) pandemic, there was serious concern that the United States would encounter a shortfall of mechanical ventilators. In response, the US government, using the Defense Production Act, ordered the development of 200,000 ventilators from 11 different manufacturers. These ventilators have different capabilities, and whether all are able to support COVID-19 patients is not evident.

Research question: Evaluate ventilator requirements for affected COVID-19 patients, assess the clinical performance of current US Strategic National Stockpile (SNS) ventilators employed during the pandemic, and finally, compare ordered ventilators' functionality based on COVID-19 patient needs.

Study design and methods: Current published literature, publicly available documents, and lay press articles were reviewed by a diverse team of disaster experts. Data were assembled into tabular format, which formed the basis for analysis and future recommendations.

Results: COVID-19 patients often develop severe hypoxemic acute respiratory failure and adult respiratory defense syndrome (ARDS), requiring high levels of ventilator support. Current SNS ventilators were unable to fully support all COVID-19 patients, and only approximately half of newly ordered ventilators have the capacity to support the most severely affected patients; ventilators with less capacity for providing high-level support are still of significant value in caring for many patients.

Interpretation: Current SNS ventilators and those on order are capable of supporting most but not all COVID-19 patients. Technologic, logistic, and educational challenges encountered from current SNS ventilators are summarized, with potential next-generation SNS ventilator updates offered.

Keywords: ARDS; COVID-19; strategic national stockpile; ventilators.

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Figures

Figure 1
Figure 1
The number of ventilators initially procured from each manufacturer and total cost of each initial contract., , , As of August 31, 2020, the initial order of nearly 200,000 ventilators has been decreased to approximately 130,000.
Figure 2
Figure 2
Full-function ventilators (in white) vs ventilators for (primarily) less severely ill patients (in yellow), noninvasive ventilation (NIV in red), or transport (in green), , , , , , , , , , , , , (based on data presented in Table 3). The designation of full-featured requires the measurement of exhaled tidal volume, display of pressure volume and flow waveforms, and precise delivery of a constant Fio2 from 0.21 to 1.0. SNS = Strategic National Stockpile.
Figure 3
Figure 3
The Vyaire LTV 1200 as delivered by the SNS in “kitted” form. See Figure 2 for expansion of abbreviation.
Figure 4
Figure 4
SNS Ventilator Lessons Learned: New York City and the LTV 1200. See Figure 2 for expansion of abbreviation.
Figure 5
Figure 5
The Public Readiness and Emergency Preparedness (PREP) Act.,
See this image and copyright information in PMC

References

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