Pacing System Helps Wean COVID-19 Patients Off Ventilators

A novel device conditions a patient's diaphragm to reduce ventilator-induced diaphragm dysfunction (VIDD), which can prolong ventilation time.

The Synapse Biomedical (Oberlin, OH, USA) TransAeris Diaphragm Pacing System (DPS) is a temporary percutaneous intramuscular diaphragm stimulator intended for patients at risk of or on prolonged positive pressure mechanical ventilation. The system is composed of the external TransAeris stimulator and one or two TransLoc electrodes, which are inserted into the right, left, or both hemi-diaphragms. The electrodes are hooked up the stimulator via surface pad electrodes and a pair of color-coded frictionless connectors. Clinical control is via a built-in user interface.

The TransAeris then provides neuromuscular electrical stimulation to the diaphragm while the patient is on mechanical ventilation to prevent, slow, or reverse diaphragm disuse atrophy and, more generally, to treat VIDD. Once the patient is successfully extubated after mechanical ventilation, the electrodes are removed from the diaphragm. The entire system is disposed of after use, thus avoiding any transfer of nosocomial infections in the intensive care unit (ICU) environment. The system has received U.S. Food and Drug Administration (FDA) emergency use authorization during the COVID-19 Pandemic.

“Trauma and high-risk surgical and cardiac patients will continue to require ICU beds and ventilators that are also needed for COVID-19 patients,” said Professor Raymond Onders, MD, chief of general surgery at University Hospitals Cleveland Medical Center (OH, USA). “In our case, utilizing TransAeris for high risk surgical and COVID-19 patients is protecting the supply chain of ventilators, ICU beds, and clinical resources by reducing the time spent on mechanical ventilators by patients at risk or experiencing prolonged mechanical ventilation.”

Weaning is an essential and universal element in the care of critically ill intubated patients receiving mechanical ventilation, and covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. It is estimated that 40% of the duration of mechanical ventilation is dedicated to the process of weaning. In some cases the process is rapid and uneventful; however, for some patients the process may be prolonged for days or weeks, due to inspiratory muscle atrophy, fatigue, paralysis of the diaphragm, or a fear of suffocation.

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