A dozen Boston area anesthesiology residents launched an eight-week hackathon hosted on GrabCAD.com to design a rapidly deployable, minimum viable mechanical ventilator for patients with COVID-19-related ventilator-dependent lung injury. The CoVent-19 Challenge was open to teams and individuals anywhere, and finalists worked directly with Stratasys 3D printing experts and the CoVent-19 Challenge team to turn their designs into prototypes for testing.

This a story of innovation in the face of a crisis. Knowing that people can come together, collaborate, and innovate for others was an important learning for everybody. Everyone was working from home. A lot of designers and engineers, though, very much wanted to take action to make something to help solve the ventilator shortage for hospitals. This is a prime example of how many people gave it their all and accomplished a lot in a short amount of time, on top of their day jobs. In the end, the experience was empowering for everyone involved.

Leslie:
Hello everyone, and thank you for listening. In today’s episode of Technology Forward, we’re speaking with Jeremiah Robinson, founder and CEO of Cionic and Daniel Zarem, senior industrial designer at fuseproject. Cionic is a technology startup focused on helping people transcend physical limitations and fuseproject is a design and innovation firm.

Together these two collaborated on a project, the VOX Ventilator, which was among the top finalists for the CoVent-19 Challenge. This challenge is the creation of 13 resident physicians, advisers, and several sponsoring organizations who have come together to create lasting solutions to the ventilator supply crisis made infamous by the COVID-19 pandemic. The prototype of the ventilator created using Stratasys’ 3D printing technology, is optimized for a COVID-19 healthcare context and can be assembled in less than four hours. Thank you, Jeremiah and Daniel for joining me today.

Daniel Zarem:
Thank you for having us.

Jeremiah Robinson:
Yeah, thanks for having us.

Leslie:
Tell me a little bit about the VOX Ventilator. Describe it for our audience who may not be familiar with it.

Jeremiah Robinson:
So the VOX Ventilator is a small, compact, pneumatically driven ventilator, which mounts to IV poles, and is able to be mobile with the patient through testing as well as through all their treatment and provides remote access as well to control the machine.

Leslie:
Okay. What were your goals for this design?

Daniel Zarem:
Our goals were really to design the ventilator to help, of course, with the COVID pandemic, but also to make sure that our ventilator met everything needed for COVID, and then some. So, that it was not going to become useless after the pandemic was over. We also really wanted to make sure that we were designing this ventilator for the peripheral experiences, not just for the technical, internal components to make this thing very reliable. We wanted to make sure that we were designing really for the respiratory therapists and the ICU nurses who are interacting with this machine on a daily basis, and that we were designing something adaptable for all different hospital settings… some that are overwhelmed with patients, as was as, those that are underwhelmed, but just don’t have enough ventilators.

Leslie:
I think if I remember correctly in looking at the entry, this is something that can be used in third world countries or in other places that may not have highly sophisticated medical equipment.

Jeremiah Robinson:
Yeah. Our goal with the system was really to create something that was highly flexible and adaptable to the environment that didn’t need a sophisticated hospital environment. It can be run off of air tanks if needed. It could be run on battery power for places that may not have full continuous power. And that really drove our decisions around the modularity of the design to build off of open source components so that it could be built with off the shelf components. No PCB boards had to be designed. No operating system software had to be created. We really set an ambitious goal. We will have a fully form-factor ready prototype by the end of the competition, which we actually delivered, which was super exciting.

Leslie:
Okay. Now, did you find any challenges in the design here? Can you go through maybe a couple of them? What were some of the design challenges you might’ve encountered?

Jeremiah Robinson:
Yeah, I’ll start and let Daniel add on. So neither Daniel nor I had particular experience with ventilators beforehand. Our company makes Bionics to help people with mobility differences achieve greater mobility and independence. And, that is a lot about sensing and analyzing data off of a human body and then driving an actuation system. So, a closed-loop censored actuation system, it turns out that a ventilator is exactly that. And we had to come up pretty fast on what we were actually looking at in the human body and what we were driving into the human body. And, we had to do that without the suite of test tools that you would typically start out with in a ventilator. So we were able to acquire those at the very end of the program. In the nature of it being hardware, you have to acquire all of the pieces and components of that design over the course of what amounted to eight weekends of work.

And so, you have this pace of development that… I mean, the software world is pretty easy because you have all the tools, but in hardware world, we’re sourcing solenoids and motors and sensors, and the fact that we were able to pursue a number of different parallel paths to make rapid changes at the end as we found new challenges within the system of delivering the proper amount of pressure and the proper amount of volume into the lungs across the fully-featured ventilator support set. So, it was a really challenging, but interesting problem made more difficult by the time constraints that were involved. And, for us that time constraint was really important, right? We’re dealing with a world pandemic, we wouldn’t have six months to develop it, we’d have to develop it in a very rapid way to address what, thankfully wasn’t a total lack of resources within the hospital systems, and hopefully will not be going forward. But, the pandemic is still ranging, and we want to make sure that other people can use our design to get this out rapidly.

Daniel Zarem:
I think to add on some of the challenges from a little bit more of the design and strategic thinking perspective that we did, especially in round one. One of the major difficulties to us was having enough interviews and deep, immersive, research to be able to make the right decisions. And, typically in our process, we would be going into hospitals and actually watching respiratory therapists using the ventilators, taking photos, videos, and really diving into the way that these machines are used in their environment, by the people that use them most. So of course, we were not able to go do that. And, all of the people we wanted to interview were extremely busy. So, we reached out through our extended network and were able to find a lot of really great healthcare employees and nurses from the East Coast, West Coast respiratory therapists, and so on.

And, we were able to get a really wide variety of responses and insight into the way that different hospitals are dealing with this pandemic, both high-capacity hospitals that are full with COVID patients, and then some that are not. So, being able to find the right people, as well as, finding time that they could speak to us. They were so busy, and they were so gracious to spend their time speaking with us and our team for an hour, or more in some cases, to really paint the right picture for us to design boards.

Leslie:
Okay. So, how did 3D printing help throughout the design process?

Daniel Zarem:
Well, we had a lot of iterations to make throughout the process. Of course, a trial of our system happened from day one, actually. Jeremiah started out with a baster and squeezing air into a pressure sensor. And, after many, many iterations, it turned into what it is now. So throughout that whole process, we were 3D printing and testing various tubes, which were a major part of our system that allowed for us to mount the pressure sensors directly onto them; a part that essentially could not be created rapidly without 3D printing. And, so we were making a wide variety of prints to test. A lot of these slightly different geometries, how we’re mounting things onto it and, going through a lot of iterations to get to the final product.

Leslie:
Okay. Jeremiah, did you use any 3D printing in your part of the process?

Jeremiah Robinson:
Yes, we collaborated quite closely. Daniel and I actually don’t live too far away. So, he had the printer and were producing a lot of our early designs. And then, when we would get something where the overall form was working on an FDM printer, we would work with our partner over at Stratasys to actually print out on their machines. Talk about the wonder of 3D printing that we could build new components, design new components, build them, and test them all within a matter of hours. And then, go and take that same design and reproduce it on a higher-end Stratasys printer, and keep that iteration going.

Jeremiah Robinson:
And so, Daniel would often print out a new part. Drop it off at my house. I would assemble it, test it with the test equipment that we had. We’d discuss it over video. We were still remote with some of our mechanical engineer designers who were helping to design those parts. And then, do it again. And, we would sometimes be able to do two or three iterations in a single day of that process.

Leslie:
Were the materials that you selected, was that a factor at all? Did that come into play or because this was prototyping, you went with just what was convenient?

Daniel Zarem:
I’d say it was a bit of both. In terms of iterating, and trying, and testing we were using FDM because it was just very convenient. I had it here and while it was not ideal and we had to chop up some of the pieces to print them, and then glue them back together, and there’s a lot more sanding involved. It was a bit more painful, but it kept us progressing forward until we were ready for the final materials and had the right geometry. I think that, yes, definitely the Stratasys printing, the materials from that were very helpful. Where we have a holding tank, and our original version that is using multi-material print. So, it’s printing gaskets directly into the body and that’s absolutely something that’s kind of Stratasys specific. And, we’re hoping to really iterate on that more throughout the development phase for manufacturing.

Leslie:
Did anything surprise the two of you about working with 3D printing in this process and surprise you about the use of 3D printing? What did you learn?

Jeremiah Robinson:
I think from our side, we use 3-D printing within our business of bionics for actual multiple reasons. I think a lot of people use 3-D printing for the ability to rapidly prototype and to iterate on manufacturer ability and design. We also use it because of its ability to adapt to custom solutions for individual human bodies. And so, our experience with this process, both Daniel’s and mine with that process was super helpful in that we didn’t have to learn.

But, one of the things that did surprise me, I didn’t actually have any experience with some of these higher end machines with some of the multi-material printing. And, just to see how fast this industry is moving and what it will mean for full-stack solutions or anything full-stack, where you’re building hardware, mechanical software, and experiences. It’s a game changer, and I’m so excited with the speed. I’m so excited with the pace at which the industry is evolving. And I really do think it will allow engineers and designers to tackle problems that they never were able to before, at a price point that really changes the dynamics of how these devices get built.

Leslie:
Daniel, do you want to make a comment?

Daniel Zarem:
I agree with everything that Jeremiah said. We didn’t run into as many surprises because we were very familiar with the machines. However, some of the materials that Stratasys was able to provide were really exciting to get to test out. And, I think that’s something that no one on the team really has had experience with yet. Some of those specific details. But, it was more exciting than surprising, I would say.

Jeremiah Robinson:
Yeah, it really opens the brain up to the possibilities of what can be done with additive manufacturing and, and multi-materials. Like, printing metal, printing mixed rubber, and plastic, and soon we’ll be printing proteins. It’s all wondrous.

Leslie:
Now, normally a question that I would ask at this point is: now that you’ve done the design, now that you’ve created the VOX Ventilator, if you could go back, would you do anything differently? But, it sounds like that was addressed throughout the process.

Jeremiah Robinson:
Yeah. There’s one very definitive thing that I would have changed, and it would have been to procure legitimate ventilator test equipment earlier. The contest organizers were able to procure for us a test lung, as well as some digital test equipment. And those were hugely valuable, and we got them very late in the process. We had to change a bunch of designs once we got test equipment in. Luckily we had been planning for that eventuality. But, if I could do it all over again I would’ve gotten that in from day one.

Leslie:
Okay. So now what is next for the VOX Ventilator? Is this something that you’re going to produce?

Daniel Zarem:
So at this point, the competition organizers have procured a manufacturer in South Africa. And, they’re reviewing our patent files and overall system and preparing to manufacture it. So, we’re kind of in a little bit of a lull right now, waiting for them to finish their review of everything. And then we’ll be working with them to make the necessary modifications for mass production.

Leslie:
And then, is this something that’s going to be sold into hospitals or maybe even the military?

Daniel Zarem:
So, yeah. That’s something that’s still in the works right now, is figuring out where exactly it’s going. I know that the pilot for a launch for this product is going to be in Africa. It’s still a little bit unclear, which specific countries and hospitals, but that’s where it’s going to start. And then, absolutely there are a lot of really valuable uses for the military; for a lot of different countries actually. Even for the UN, for a lot of different people that are in different countries that need this medical equipment for more impromptu stations to help treat patients.

Jeremiah Robinson:
It’s an important question, because I think when we started this project, it was unclear if the world would need these low-cost, rapidly-reproducible ventilators. I would say it’s still unclear. As I said before, I really hope that the world doesn’t need them. But, if we were at this point and we look back and we could have done something and didn’t do it, I think we would feel a real sense of regret if the world does end up needing that. And, we’ve had people reach out from us from a number of different places. Because we did put our designs into the open source community, as a reference design that people can look at. We have ad people now expressing interest. Some folks from Southeast Asia, from South America, and of course, what Daniel mentioned in West Africa. And, our goal was not to, make money with this project. It was to provide some help in the overall crisis. So, we’re supporting the efforts of others to bring that to market. And, we’ll do what we can to make sure that if it’s needed, that we will be there to help.

Leslie:
Well, at least the CAD files are available. And fortunately, we’re shifting over into digital manufacturing so that this is something that if it’s ever needed, the design has been done.

Jeremiah Robinson:
Absolutely.

Daniel Zarem:
Yeah. Both the CAD files, as well as the source code, and all of the test protocols are all available.

Leslie:
Yeah. Do either of you want to make any final comments about this experience?

Jeremiah Robinson:
I mean, for me, one of the things that, I walk away and feel I’m very proud of what can be done by people with great talents when faced with this external crisis. To come together. No one got paid. Everybody worked super hard to build something that… At the start, when Daniel asked me if we could help put together a fully functional ventilator over the course of eight weekends, I was like, “Wow that’s just really impossible.” But, it’s a real story of innovation in the face of a crisis. And, I think in this time especially, when faced with something like this in the world, knowing that, that is possible. Knowing that people can come together, collaborate, and innovate for others. I just think is just a really important learning for us and for everybody.

Daniel Zarem:
Yeah. I completely agree with that. You know, it was pretty remarkable to get to work with the group that we’d assembled, partially in Seattle, and San Francisco, and the Bay area. This all started at the very beginning of working from home. So, on top of everybody else’s work and adjusting to how to work from home effectively, everyone really on the team stepped up because they really cared and wanted to make sure that we were doing something to help out. I think a lot of designers and engineers alike, really very much so wanted to take action to make something to help solve the current problems going on. And, this was just a prime example of how so many people wanted to do that so badly and give it their all, that we were able to accomplish a lot in a short amount of time, on top of our day jobs. I feel very grateful that to have gotten to work with so many people that were like that. It’s very empowering, I guess, you know? To see what really can be done with a group of people that really want to do a lot.