A Breath of Fresh Air

According to the World Health Organization (WHO), pneumonia, tuberculosis, influenza, lower respiratory infections and whooping cough are some of the leading causes for death among Africans. Many of these diseases are preventable and treatable in adequately funded healthcare systems. However, many regions in Africa do not have adequate resources to handle the influx of patients with respiratory issues.

During his medical internship at the Lagos University Teaching Hospital (LUTH), in Nigeria, Dr. Dayo Olakulehin identified a significant challenge that affects patients’ critical care. Ventilators are required to help many patients breathe; however, they are very expensive, costing upwards of $20,000, and sometimes inaccessible.

“For the majority of people, who aren’t able to afford [a ventilator], the existing alternative is for health workers, doctors or nurses to indefinitely use a CPR bag to ventilate the patients and keep them alive,” explains Olakulehin. “It is a very tedious, tiring and ineffective process.”

Olakulehin came to Canada with an idea, to create a product that would automate or replace a person manually squeezing a CPR bag. With the help of Toronto-based design engineering firm, Inertia Engineering + Design, Olakulehin developed the D-Box.

The D-Box is an inexpensive, portable and rechargeable alternative for manually pumping a CPR bag when a ventilator is not an option. Olakulehin named the device after himself, the “D” standing for Dayo.

“It was a pretty compelling product idea from the start and one that we thought we can help to get to the point of demonstration prototype or proof of concept, fairly quickly,” says Ray Minato, president and CEO of Inertia Engineering + Design.

Minato and his team began researching the applications for such a product and came to the realization that Olakulehin had identified a significant problem in the healthcare field, not just in Nigeria but all over the world.

For example, Minato says that he found identical situations in India where, “a family had to manually pump one of these CPR bags for a month for the father because he had a certain illness.” Eventually the father got better, but the mother and son were forced to pump air for an entire month straight. “It gave us some additional validation that the product is not just a single occurrence.”

Olakulehin worked with a four-person team led by Manjunath Anand at Inertia to develop his concept. One of the first things the engineering team needed to understand was what a ventilator-like product absolutely needs to do versus value-added features. Minato explains that the D-Box works by inserting a standard CPR bag, typically found at any hospital. It takes the place of a person, who would manually need to pump the bag. This device is not meant to compete with the typical medical ventilator but rather act as a portable option when one is unavailable.

The goal for the Inertia team was to provide Olakulehin with a product to bring to the market fairly quickly. The cost of the product was a significant obstacle for Inertia; it needed to be at a price point affordable for resource-limited areas of the world.

One way to keep costs down was to design a concept with inexpensive and readily-available material. The D-Box is made with a plastic enclosure and plastic and steel mechanisms and includes electric motors. For increased reliability, Olakulehin and the design team included a 12-hour rechargeable battery to allow for continuous operation in the event of a power failure, a common occurrence in the developing world.

“That was just one example of an absolute need,” explains Minato. “Everything has been optimized for low cost but high reliability.”

Olakulehin adds that the D-Box automates the pumping of a CPR bag with more reliability than a human could have done in situations where a traditional ventilator is not an option. The Inertia team was able to design the D-Box at an affordable price point, in the hundreds of dollars range, rather than costing tens of thousands of dollars.

Designing the drive system and mechanisms posed a challenge. There are some subtleties in the way a bag is compressed with a rigid mechanism versus a hand.

The team needed to ensure that the motion and shape of the mechanism were able to interface with the bag without overstressing it, which can cause failure. An added challenge was designing this in a way that was well within the cost parameters.

At the moment, the D-Box can only accommodate adult-sized CPR bags; however, Minato mentions that future designs could be made to include infant-sized bags, which are quite a bit smaller.

Using a “smart” CPR bag in the D-Box allows for regulated output pressure, as these types of bags limit the excessive flow of gas into the patient’s airway.

In December 2015, Inertia had developed a functional prototype. The proof of concept included parts that were manufactured using CNC machined plastics, metal stampings, printed circuit boards, etc. Olakulehin has since returned to Nigeria and presented the product to the medical community in Lagos.

“We wanted to emphasize that this device doesn’t replace the [traditional] ventilator,” says Olakulehin. “If they can afford access to one, that is the best option. I am very aware that there are many places in the world where this isn’t the case. The D-Box is just one mode of ventilation—intermittent positive pressure ventilation (IPPV)—and offers portability.”

An additional benefit is that critical care certification isn’t needed to use it, which is crucial in areas of the world where access to medical professionals is limited.

“The reason for developing the proof of concept prototype was just to demonstrate the idea to people in the physical form and understand the challenges around developing a product like this,” Minato says. “We have designed and developed a proof of concept prototype just to show, yes you can create a mechanism that will pump the CPR bag as you would do by hand, at different speeds and limited functionality.”

Inertia Engineering + Design and Olakulehin have entered into a business partnership to bring this patent pending product to market. The design firm is responsible for all product design, further prototyping, testing and managing the manufacturing process.

“Ultimately, it will all come down to price and flexibility,” adds Minato. “We are expecting it to be a fairly high volume product, in the tens of thousands if not the hundreds of thousands.”

www.inertiaengineering.com