Today on the show, I talk with my friend Jim DuCanto, MD about the oxylator. Jim is an anesthesiologist extraordinaire with a constant drive to perfect new airway techniques and document them on video along the way.
What is the Oxylator?
A mainly plastic device about the size of your fist with a incredibly quick magnetic valve
It runs on pressurized wall or tank oxygen
Only two main controls, a pressure setting knob and a manual inhalation/automatic mode button
Manual Resuscitator Mode
Press the button and the device will give 30 lpm of inhalation until you let go or it hits the pressure limit you set
Automatic Ventilator Mode
Press in the button and give it a turn and the device switches to automatic ventilation mode. Think of it as a flow-controlled, pressure cycled ventilator in your hand
It gives 30 lpm fixed flow (slow, safe flow) until it hits the user-selectable pressure limit, it then cycles to passive exhalation until it reaches 2-4 cm H20 PEEP and then it begins a new breath
On a patient who is not spontaneously breathing, you can titrate that pressure setting to an inhalation time of 1 seconds; this will deliver 500 mls per breath
At those settings, the minute volume will be 10-12 liters/minute
Feedback
The device indicates when you are obstructing by clicking and tells you when there is a mask seal leak by not cycling to the next breath
It Solves the 5 Problems of the BVM
- We give too many breaths
- Those breaths are at too high a pressure
- The breaths are given too rapidly
- We get no feedback on whether the breath went in or it was given against an obstructed airway
- In a spontaneously breathing patient, the BVM will give variable FiO2s depending on the exhalation port
How we use it
We both use an inline HEPA filter, ETCO2 port, and sometimes extension tubing. If you want to use it on a spontaneously breathing patient, OR mask straps are a great addition.
Two models
EMX (25-45 cm H20) and HD (15-30). There are also specialty models for chemical/explosive situations.
Here is Jim's Overview on the Device
And here are the Slides from a lecture Jim gave at SAM
Here is an example of the use of the Oxylator for an OR Induction
Nasal CPAP in Unconscious Patient is More Effective than Full-Face Masks
Crit Care. 2013 Dec 23;17(6):R300.
Oxylator Product Page
This is the EMX Model
Disclaimer and COI
Neither Jim nor I take any money, kickbacks, or incentives from the manufacturer. Both Jim and I have been provided with Oxylators to test and research.
Additional New Information
More on EMCrit
- EMCrit 196 – Having a Vomit SALAD with Dr. Jim DuCanto – Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding(Opens in a new browser tab)
- Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD(Opens in a new browser tab)
- About the SALAD Technique(Opens in a new browser tab)
Additional Resources
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Interesting material, thank you. In my hospital we primarily use the Oxylator for all in-hospital resuscitations (we’ve got one on every ward). Our code-cart has a BVM, but we got rid of them on the wards since it’s just much easier to adequately oxygenate a patient (and much more difficult to injure them) with an Oxylator. When we introduced the Oxylator, our anesthesia service would bring nurses in to the OR to get a feeling for them in real life, which I found a good idea. Our ambulance service also has an Oxylator and I’ve seen it used in cardiac… Read more »
thanks, Patrick. Jim is going to reach out to you.
Patrick, can you advise me if you work for a US based system? I am wanting to know how prevalent this devise is in the US vs Europe and Asia. Is it becoming standard use in cardiac arrests for your system? Thanks!
Hi Michael, I work in Switzerland. Over here its use is heterogenous and depends very much on the service you work for, as far as I know. Although its use has increased lately, I would say that many of our teams will still use a BVM either due to habit or for some due to preference.
We been using the oxylator as a standard of care for assisted ventilation for a long time in the prehospital in the province of Québec. It was adopted as a replacement for the pocket mask, because we never agree to use facemask BVM. They also developed a technique of assisted respiration in acute respiratory distress (pretty much like a Bipap) using tubing to increased the death space and setting the oxylator at 20 cm h2o, that will gives 10 cm h2o of inspiration pressure to the patient. http://www.youtube.com/watch?v=j3I2Sb5yVhU
Hoping my english is not too bad, thanks for the good education!
Dominic, Your English and the video are great!!
BVM is the devil pendulum swing is unfounded. BVM is tremendous tool, it’s all about using the proper tool for the job. #1 Oxylator is a pneumatically powered device (nothing new here anyone remember bird mark 7 ventilator?). The fact that it’s pneumatically powered or it wont work is a negative in itself. Pneumatically powered devices go through O2 tanks in a few minutes and then what do you have? A device that does not work. “Oxylator requires 2 things in life to work 1) pressurized gas supply wall or tank of 55 PSI) and an open airway and or… Read more »
Hi Nikolay, Let me expound on the issues you brought forth. 1) Compressed gas consumption: The Oxylator consumes 15 liters per minute during operation, which consumes a full E-cylinder in about 45 minutes, and obviously smaller tanks get consumed more quickly. The device was developed as a Resuscitator, that is, a ventilation device to be used in resuscitation. It can be used as a transport ventilator, but that is not its primary purpose. Gas consumption can be lessened with a flow-reducing hose, which is a device available from the manufacturer that will allow a reduction in the minute ventilation of… Read more »
Dr. Ducanto the unit is a nice toy, it’s nice to have that’s all. It still is not a replacement for a standard BVM (as BVM does not have to be pneumatically powered like the Oxylator to function plus it has a PEEP Valve Adaptor and most first responders will know how to use it had you asked for assistance) and it’s not a replacement for a transport ventilator (Oxylator is pneumatically powered and has no PEEP). It does not replace a BVM, has no PEEP and is greatly inferior to a Transport Ventilator (with Pplat, PEEP, Basic Modes which… Read more »
great work Jim and Scott! The Oxylator is a great innovation in resuscitation care, especially for prehospital setting. I have to provide support for the much maligned BVM or self inflating manual resuscitator, though! That is still too, a simple and resilient design and it does something that the Oxylator cannot…work without any gas supply! Having run out of oxygen in the prehospital setting, this I find can be a very handy thing! The oxylator has an adapter gas cable that blends the oxygen/air mix to reduce FiO2. aS we all know, variable FiO2 can be handy in certain conditions.… Read more »
Yes, definitely still need a bvm for back-up if the O2 runs out, but the oxylator should use less O2 than a BVM overall. The minute ventilation of the oxylator is right in the sweet-spot for pretty much any pt except severe acidosis. Should get you in the PaCO2 ~35 mm Hg range. The approval of the PEEP adapter is key.
Hi Mihn, The Oxylator is the device for the initial Resuscitation, the preoxgenation and ventilation during airway management and the transport to the aircraft or vehicle. You try to avoid bringing sensitive transport ventilators into places that can ruin them, like water filled ditches, etc… The Oxylator, in contrast will work in water (and shortly will be shown to actually work underwater), so it has an unheard of durability for an automated ventilation device. The EtCO2 can be regulated with a flow control hose. This flow control reduces the minute ventilation by reducing the flow through the device from 30… Read more »
Interesting. Brings me back to the 80s when a “demand” valve was on every ambulance and EMTs/first aiders used them. They moved away from them out of fears of overinsufflation. It certainly is much easier to use than the bag. It does not do much for improving the seal. http://en.wikipedia.org/wiki/Resuscitator
Hello,
Very interesting!!
The Oxylator sounds like a much improved Flynn Resuscitator I learned about back in the day when I did my military medic course. I totally forgot about it.
I think this could be beneficial with the service I work with.
http://www.youtube.com/watch?v=VejNuhyR1x0
Thank you,
David Hersey
Excellent topic! In researching Oxylator compatablilty issues I came across this language in the FAQ section for the ResQPOD ITD. Can I use the ResQPOD with the Oxylator? No. In the automatic mode, the Oxylator provides a continuously positive airway pressure that is harmful for the patient, with or without the ResQPOD. This continuously positive airflow interferes with the ResQPOD’s ability to create a vacuum (negative pressure). ACSI and the American Heart Association discourage the use of the Oxylator in the automatic mode during CPR, it will decrease circulation. Thoughts? Should the Oxylator not be used in automatic mode in… Read more »
Hi Chip, I do challenge the statement in that FAQ from the ResQPOD–the positive pressure from the Oxylator is not harmful to the patient–it simply neutralizes the Impedance Threshold function of the ResQPOD when the Oxylator is used in Automatic Mode. If using the Oxylator with the ResQPOD, you simply use the Manual Mode, with the periodic press and release of the O2 Release button. Once ROSC occurs, you would remove the ResQPOD and set the Oxylator to Automatic mode. You can use the Oxylator in the Automatic mode during cardiac arrest, just not with the ResQPOD. But if the… Read more »
Chip, I have the same trepidation of automatic mode compared to intermittent in cpr; as ZEEP or even negative pressures during upstroke of compression seems essential for venous return. I think for mask ventilation (as in no SGA or ETT), the oxylator on automatic is markedly superior to the alternative of stopping after every 30 compressions. The oxylator will sneak in breaths between compressions. So if I had my druthers during CPR, oxylator on automatic with a mask and then as soon as you have an SGA or ETT, switch to intermittent holding down the button until a breath is… Read more »
If the flow is fixed at 30 lpm what happens if the patient is spontaneously breathing with flow rate demand higher than 30 lpm? I have been at codes where the patient seems to be “sucking” the bvm with high inspiratory flows. Would the fixed 30 lpm be detrimental in these cases?
The Oxylator is open at the top (at the exhalation valve) and will permit the patient to entrain room air if they demand more than 30 lpm on the I-phase of ventilation. It sounds a little like the sounds that Darth Vader makes when he is breathing, so it is totally obvious when this occurs (unless you are in a noise filled environment like a helicopter).
unless you add the PEEP valve (even on zero) (have I mentioned how much this device needs the PEEP valve adapter approved). At that point, the pt will be a little frustrated, but will only get 100% fiO2. This is the same situation as in most BVMs.
Nice device but insanely overpriced item.Weight 0.25 kg;( 0.55 lbs) Dimension dia * length 2.25 in. * 4.25 in., (57mm * 108mm) plastic cylinder, some valve inside with 2 meter hose. production costs about $ 5-10 USD .I know research and development, patent etc bla bla.
MSRP: ~ $1000 !!
take a look inside your $15,000 vent–you may be surprised
Hi guys, Don’t judge a book by it’s cover–the device is reusable (does not have a projected number of uses at which it needs to be replaced, like some devices) and is actually made on machine tool machinery, not cast like a cheap disposable device. The Delrin plastic is pretty robust and machinable. Anyway, I hope you go to the trouble of getting your hands on one and putting it through its paces. They are available on the used equipment market for a discount, but these are usually models “diverted” from the military in the US, always without proper authorization.… Read more »
Another question would be how much a bad outcome costs – those are costs never factored in, since one just assumes that all cardiac arrests aspirate, the guy was a difficult mask, it was fate, etc. How much are you willing to bet that you are not getting any air into the stomach in your next difficult mask? Here’s another question: how much is an extra pair of hands worth in your next cardiac arrest – with the Oxylator you not only have an excellent oxygenation device, but you have a pneumatic ventilator the size of a fist in your… Read more »
There really is no need to justify the cost. $1000 is ridiculously cheap for reusable medical equipment like this.
How does it works with very sick lungs?What do you think about its use in selective population like the severe asthmatic, COPD exacerbation, ARDS, SCAPE, DKA, TBI and/or the hypotensive patient. My question concerns more the automatic mode. Any counterindication or risk of harm?
Thanks.
It works quite predictably with sick lungs, although it provides limited PEEP (4 cm H2O) unless you use the “COVID Cap” which will permit the fitting of both an additional HEPA filter (if you so desire) and a standard PEEP valve. Any additional PEEP you apply through this valve adds on to the PEEP supplied by the Oxylator–so 5 cm PEEP setting on the external PEEP valve will produce 9 cm H2O PEEP total. It will not support breath stacking in COPD /Asthma, as the automatic mode will not begin a new inspiratory cycle until the airway pressure passively falls… Read more »
Jim DuCanto has made an even better video explaining the Oxylator (including the optional PEEP adapter). Scott, maybe you could consider to use that video in the main text above.
IPPB was used many decades ago, I was a respiratory therapist before med school. This is VERY similar.