Lockdown Innovation –SAMBU – Through the wild eyes and by the disciplined mind of an anaesthesia resident

Sir,

Innovations in health care are costly and time-consuming. In addition to that, India being a developing country, has limited financial resources. The scope of postgraduation in anaesthesiology is so abundant that the residents can use their wild minds and disciplined eyes to create life-saving yet cost-effective devices. Some of the new ideas designed to minimise aerosol generation during the corona virus disease-19 (COVID-19) era included aerosol boxes,[¹²] corona curtains,[³] railway coaches transformed into COVID-19 care centres,[⁴] face shields made out of transparent over-head projector display foil, bacterial/viral filters attached to an anaesthesia face mask and many more.[⁵]

During the final year of my postgraduation, I made a no-cost manual resuscitator by the name ‘SAMBU – Sathya’s artificial manual breathing unit ’ from an empty intravenous fluid bottle. The materials required were one intravenous fluid plastic bottle (1 L bottle for adults and 500 mL for children, one right-angled connector and two syringe caps). The bottle being compliant, recoiled easily with oxygen or even room air. A round incision was made on the hanging side of the bottle along the inner diameter of the hook, and a circular opening was created. A right-angled connector was inserted in the opening which fitted snuggly with no air leak. One syringe cap was inserted onto the nozzle of the injection port through which oxygen tubing from the flow metre or room air can enter and one more syringe cap was inserted as a side vent for carbon dioxide [Figure 1].

Figure 1: ‘SAMBU’ –Outline design and equipment. ET: endotracheal; CO₂: carbon dioxide

‘SAMBU’ can be used in situations like in a remote healthcare facility where there is no/limited availability of the AMBU and it is being required by more than one patient or during travel for unanticipated emergencies requiring resuscitation. It can be used to generate positive-pressure ventilation temporarily till a definite solution arises. My experience with SAMBU involved its testing in test lungs and also in mannequins. To date, there have been no instances in real life which required the use of the ’SAMBU’ in a living patient. Efforts are being made for filing the patent rights of ‘SAMBU’.

The shortcomings of this device are that most of the intravenous fluid bottles come in a volume of 500 ml and deliver less than the required tidal volume in adults, whereas an intravenous bottle of a capacity of 1 L or more for manual resuscitation is required for making the ‘SAMBU’. Manual resuscitators in general carry a high risk of aerosol generation if used in COVID-19 patients with unprotected airways.[⁶] The ‘SAMBU’ can also be a lifesaver in emergency situations like ventilating patients with a cricothyroidotomy. Nevertheless, as the famous saying goes, ‘Necessity is the mother of invention’, the COVID-19 pandemic has encouraged doctors to create innovative ideas to meet their needs. Innovations are the cornerstones in the amelioration of anaesthesia practice including the improvement of patient safety and outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.