Did you know that we take about 20 000 breaths every day? Often times without even thinking about it...

We don't think about it because it just works, but what happens when it does not work?

In my research I met Linn, she is today 10 year old and her lungs stopped working when she was on a plane traveling over the Atlantic two years ago. The plane needed to do an emergency landing in Ireland to get Linn the treatment she desperately needed. But unfortunately the treatment in Ireland was not enough and a specialized team with doctors and nurses were flown in from Sweden to bring her back to her home country. Linn got a second chance to life. This last chance treatment is called ECMO.

ECMO stands for Extracorporeal membrane oxygenation, which means that it is an artificial lung outside of the body providing the patient with oxygen. In Sweden we have one of the best ECMO Centers in the world. They are the best of the best, but their equipment looks old, overwhelming and scary.

In an environment like this life can depend on seconds and therefore the equipment needs to be bullet proof. Unfortunately, in my research I found that this is not always the case. I studied this complex ICU environment to find interesting design opportunities.

I found that there were cables and tubes everywhere not making it easy for the staff, the complex circuits creates an overall bad structure that is not optimized for the environment. And moving around the ECMO within the hospital was definitely not the easiest thing.

After studying these issues, I designed Adoxy, a compact and complete ECMO System where emphasis was put on simplicity, integration and a small footprint. The components were combined into one product to optimize space and clean up the appearance, therefor getting rid of unnecessary tubing and connections that could be integrated in the shape.

The multiple screens on the old ECMO is now accessible from one bigger screen for easier interaction and better work flow for the staff. The most important part of the ECMO can be released from the hospital cart and placed closer to the patient when needed or attached to another cart that will be more suitable for transportations outside of the hospital.

As use of this treatment is expanding the ECMO machine needs to be simplified to have a chance to spread and make the treatment more accessible to a larger scope of patients and hospitals.

BACKGROUND & RESEARCH

ECMO, Extracorporeal Membrane Oxygenation, is out of body oxygenation through an artificial lung in the event of severe respiratory failure when conventional care falls short. The usage of ECMO on adult patients is increasing steadily (see graph in attached pdf.) more and more diagnoses are treated with this rare and exclusive treatment. Today ECMO is only used on patients that have an 80% or higher risk of dying within the following 24 hours, because not many hospitals have the knowledge and resources to efficiently and, sometimes, properly operate ECMO machines. The treatment is complex, and often times overwhelming, for both patients, their relatives and also for the ECMO specialists within the Intensive Care Unit.

Today different components are put together to form an EMCO device and this creates a very complex circuit between the patient and the machine. The complexity adds room for failure in the circuit and in severe machine failure the staff has about 60 seconds to troubleshoot and change a component of the ECMO. Therefore, the treatment needs to be simplified, better structured and fit the right context to become accessible to a larger scope of patients and facilitate the needs of the staff working and monitoring theECMO and patient 24/7.

What if the treatment could be simplified and therefore more accessible to a largerscope of patients?

Research was gathered from two hospitals in Sweden, Stockholm and Umeå, and a third hospital in the United States, Indiana. The video in the application shows parts of the research process and the creative work during the project, please have a look!

From the Research three Areas of Interest were identified to bring into the creative phase. -Cable & Tube Management -Overview & Structure of Equipment -Mobility and Flexibility

CREATIVE PROCESS

The creative work consisted of brainstorms with both designers, clinical experts (doctors, perfusionists, nurses) and engineers. Ideas were tested in an iterative and quick process to grain momentum forward where the close collaboration with clinical experts was a key to find and confirm interesting ideas.

Throughout the process more hospital visits were possible and every chance was taken to get more input and learn more about this interesting and complex topic.

Mock-ups were built combined with sketching and feedback-sessions to create different concept directions. One direction was taken further due to compactness, flexibility and integration, all qualities that are vital for a intensive care environment and especially tailored to the ECMO needs.

RESULT

The final concept is Adoxy, a compact ECMO system that reduces cables and automates and streamlines the opertation. The oxygenator (artificial lung) placement is easier, more accessible and more protected for safety and usability. Through design it reduces the chance of human error by easier handling and fewer steps in the process helping the staff in their already stressful workday.

All the different components needed for the treatment (ECMO, water heater and gas blender) are combined into one machine. As a result, operation maintenance and information is accessible on a single screen for easier & quicker interaction for the staff.

Components are shuffled around from todays solutions to optimize space and create a better machine archetype. Cables and connections, gas tubes and extra cords are integrated in the machine and creates a calmer impression of the whole ECMO system, also creating a better environment for the staff, but in the long run; also for the patients and their relatives.

Modularity

The most vital segment (the brain) of the ECMO can be released from the hospital cart. The final product comes with two different carts, a ward/hospital cart (shown in this concept), used internally in the hospital and an transportation cart (not yet designed), used outside of the hospital. Alternatively, the transportation cart is lower in profile to fit in an airplane or helicopter, when staff is picking up patients at remote smaller hospitals and bringing them back to ECMO Centers.

Faster Priming

When a patient is being put on ECMO, the machine needs to quickly be primed and ready. Today there is no structured way of executing the priming, therefor it can take up to 15 minutes to get a machine ready. This could be a safety issue for the patient waiting for the treatment and stressful for the staff.

Adoxy enables a well thought through way of priming, where everything has its place. When the set-up is done the priming pole can be integrated in the machine and hidden, to avoid the pole being used for storage during operation and creating a messy work environment.

Extended Screen

Adoxy is connected to the patient monitoring system, to enable a larger and more focused display for the nurses within the Intensive Care Unit. This is a safety issue where in critical situations the nurses are working close to the patient and need to be able to see the information on the ECMO screen from a further distance, therefor an extended screen is needed and helpful for prioritizing according to the situation and helping the workflow.