How I got involved with exovent – by Ian Joesbury

I first heard about exovent during lockdown in early April last year. Out of the blue I had a call from Claire Davidson, a great friend from DRD Partnership asking if I would be interested in getting involved with exovent. Like many people I was keen to help with the battle against Covid and as Claire described what exovent was, a modern version of the Iron Lung, and how it worked I was struck by how simple and safe it was and how easily it could be made and used.

The thing that really confirmed my decision to join exovent was the team. Although it was a great idea, most good ideas fail to develop for one reason or another, mainly not for technical reasons. If you are going to be successful in Product Development what you need is a committed and capable team and I could see immediately that exovent had a truly amazing team. Although the original idea came from Dave McKeown, an engineer working for the government on flood protection, the majority of the team worked in the NHS, Anaesthetists, Critical Care Specialist, Senior Nurses, Surgeons, Paediatric Consultants and many more.

It soon became apparent that not only did we have some great medics but we also had amazing scientists and engineers, working with cutting edge materials to create the latest medical device technology. Nick Ryan from Steer Energy has been part of the team from the beginning and we were working with Marshall ADG (a leading global Aerospace Company and experts in delivering bespoke complex integrated solutions) and Warwick Manufacturing Group (part of the University of Warwick specialising in knowledge transfer in Engineering and Technology). Within a few weeks of getting involved the team at Marshall ADG, working intensively using rapid prototyping techniques, had built a fully functional and robust system. This gave us a great step forward but in fact was just the start of the very complex journey to get a medical device approved for use.

The more I understood what was happening the more I was struck by the challenge in the patients journey with Covid. In hospital in many cases patients will be put onto piped oxygen with a facemask and then perhaps quite quickly onto CPAP. As the patient deteriorates then there comes a decision point where the doctors will anaesthetise and put a tube down the patients throat to ventilate them. Ventilation is lifesaving, but it is still a challenging and traumatic patient journey of care. Some people find CPAP, which is continuous pressurised oxygen/air in a face mask firmly strapped to your face, uncomfortable and difficult to tolerate over extended periods of time. Also the trauma of having to say goodbye to your loved ones when you are faced with being anaesthetised and not knowing if you will survive must be so difficult.

Exovent is not in competition with CPAP and Intubation but once medically approved it would offer clinicians some alternative ventilation options if they felt it appropriate. The exovent has an enclosure that goes around a patients chest and puts a negative pressure on the patients chest. CNEP continuous negative pressure will open up the lungs and with an oxygen facemask or nasal prongs supplying oxygen, is the negative pressure equivalent of CPAP. This is comfortable and readily tolerated and actually makes the work of breathing easier. If the patient deteriorates further it is then possible to smoothly transition to alternating the negative pressure in line with normal breathing rates which will initially help the body with inhalation and exhalation and ultimately be increased to the point where all the work of breathing is being done by the exovent. At this point the patient is receiving the benefits of ventilation but is still awake, can talk to their loved ones, eat, drink and tell the doctor how they are feeling. If the patient deteriorates further there is still the option to intubate the patient as before.

We hope to submit the system for approval in March of this year, and hope that by September we might have approval for the use of the system.

As a charity, everything we have done has been for free. Costs have been borne by ourselves individually and our partners. Ultimately we expect the manufacturer to make a modest profit from the system to ensure that it can continue to reinvest and spread the technology. We do need support to help the charity function (there are no paid staff) and to help us develop adult and paediatric systems for low income environments (a child dies of pneumonia every 40 seconds and many of them have no access to any form of ventilatory support).  Any donations you can make through our gofundme page here would be gratefully received. It will cost well over £1m to develop and approve the low cost systems and every penny received will help us on that journey.

Take a look at Ian’s video with That’s TV South here

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