Yes, this is an impressive amount of work done in a few weeks by a small team at Tesla. However, medical devices, especially for life support systems, are not a Hackathon project.
These devices breathe air into patients lungs. They need to be manufactured in clean room conditions, with medical grade parts, not plumbing parts from a big box store. They must be designed and tested to ISO specifications. If this fails, the patient can die.
I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency.
The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
> However, medical devices, especially for life support systems, are not a Hackathon project.
This effort they're doing really doesn't seem like they're treating it like a "Hackathon" project. They're putting real engineering resources behind it.
Whether or not they can produce something in time is still up in the air, but it seems to me Musk is attacking the problem from several different angles and hoping something works: he's purchased off the shelf BIPAP equipment and donated it (which turns out to not be as useful as hoped), he's got engineers homegrowing what appears to be a legit ventilator that may or may not get to volume production and/or certification in time, and he's helping established ventilator manufacturers with some of their manufacturing bottlenecks.
All three of these approaches are unlikely to be fruitful, but at a time when we're desperate and looking for quick innovation, it seems strange to dismiss people with the resources to try.
If these patients receive no help, they die anyway. Given the choice between almost certain death or some experimental piece of hardware - give me the experimental hardware.
> I can't imagine any hospital or doctor careless enough to
> connect one of these to a patient, even in this current
> emergency.
I'm sure they will go through accelerated testing.
> The smarter idea is to ramp up existing proven designs,
> not reinvent the wheel and basically do a publicity stunt
> about your engineering talent.
Retooling has an enormous cost too (time and money) - yes the design will be proven but you won't nearly have the tools or expertise to implement them.
I'm not a Tesla fan-boy by a far shot, but I don't think they deserve this hate for what is clearly a good effort on their behalf.
So discouraging to see such low quality and cynical comments at the top level here.
It's been made very clear over the weeks here on HN how Tesla and SpaceX between them, with their overlapping engineering resources (Elon, for example) have deep experience with life support systems, at a level approved by NASA even. To diss their work as a hackathon project is pretty low.
It's also been widely discussed that this crisis requires us to try some new things, and think outside of the box.
Elon donates massive quantities of masks and various types of the specific breathing devices asked for by medical facilities, and then takes it to the next level, putting his company reputation on the line, and you call it... a publicity stunt.
But when Jack Ma donated masks with a lot of fanfare, you said...
>Kudos to Jack. ... this shows selfless entrepreneurship.
Seems like a bit of a double standard.
>The smarter idea is to ramp up existing proven designs, not reinvent the wheel
Reinventing the wheel has a long history of success. But that's another story. Closer at hand, they already addressed this in the video, and why they did not take the path you thought would be smarter.
Specifically, just to reiterate what was made very clear in the first few seconds of the short video, it would impact supplies needed by existing manufacturers.
The whole point of this project is not to use up supplies needed to build ventilator but to compliment the ventilators they are already building by using Tesla parts.
This is fundamentally a logistics project. Plus, they have access to Medtronic engineers, and as long as the FDA approve the devices, I have no problem with it.
I knew someone at Hacker News will make a comment like this. Hacker News is cynicism at its finest.
"I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency."
This is utter BS. Imagine that you are in a situation where you are trying to ration lives by selecting who gets access to a ventilator. Won't you not use this device then too?
Please, for god's sake, appreciate and be thankful that we have such great companies in US trying to help our people out. For perspective, if you were in a developing country, like India etc., all you have is hope and no company will be stepping up (they just don't have the technical wherewithalls).
In the current situation, I doubt anybody will give any regard to your sentiment. Though, I myself will.
> The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
This is what China did. Ctrl-C, Ctrl-V, and knockoff ventilators began to fly off assembly lines in less than a month.
P.S. In other news, A VERY BIG THING that no news seem to be reporting. China has effectively banned nearly every medical export as of April 1 through enforcement of impossible to comply paperwork:
A man I know, who works at a medical clothing, and bedding factory, says that even such basic things that should not require any certification are now banned for export.
At the beginning of this, Musk said that he didn't feel like new companies (including his) could get production going in meaningful quantities by the time that they would be required. I see nothing from Tesla that indicates that has changed, and I think that largely agrees with the point that you are making.
Your last point is important, I think. Notably, Tesla & SpaceX have been working with Medtronic to provide solenoids that are apparently a bottleneck in Medtronic's production process. It wouldn't surprise me to hear that others are also working on supplies for existing production lines to help with more rapidly ramping production. I think this is more likely to be useful.
How much of all of that clean room conditions is truly necessary? I ask not to be combative or to just support Tesla, but I know the US has a habit of only accepting the absolute best medical equipment, whereas hospitals make do with good but not great equipment and are able to save lives and save money. There is a risk, but there is also the issue of peopling dying because of no ventilator. So what's better? Having no ventilator, or having an one that gets the job done but isn't made with "medical grade" equipment.
If a doctor believes it is 99% likely that a patient will die without a ventilator and none are available, then why wouldn't they try something like the one from Tesla?
A choice between almost certain death and possible life isn't really a choice.
This is overly dismissive and clearly just a “negative for the sake of being negative” comment. I’m not a Tesla fan, but these arguments don’t really hold water and are very insufficient to just dismiss the whole thing out of hand.
Three weeks ago, "hackers" here were posting their ventilator "designs" based on Arduino ducktaped to a CPAP machine and getting hundreds of upvotes. Now Tesla cooperating with actual medical equipment manufacturers is not legit enough?
> The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
Those are not mutually exclusive. Yes, it would be great if we could produce more ventilators, but Tesla has no impact on "real" ventilator production either way.
This is obviously a PR piece. I see nothing wrong with a company trying to improve their brand's perception by trying to save lives.
This is an entirely self-serving PR move. Anyone at Tesla knows that getting government approval on any sort of ventilator they construct will require at least 6 months, probably 12, of rigorous testing. This isn't doing anything to truly solve this crisis.
Partnering or giving resources to companies that already have approved ventilator designs would by far be more helpful.
If it becomes a battlefield medicine situation, what should happen?
I remember reading that during WW2 when there was no penicillin, nurses would inject milk I believe into patients, hoping it would stimulate an immune response and save the patient. Seems kind of risky, what are the ethics?
That's great. I hope wiper motors can take that kind of continuous actuation -- it's not really what they're designed for. I'm sure they'll stress test the hell out of it.
That's actually really impressive. I didn't realize any of these efforts were that far along. It will be interesting to see how long certification takes.
Are ventilators even helping? I see numbers like a 30% survival rate in some places, but they don't mention if that means "aren't dead yet" or recovered and removed from the ventilator. I definitely read about people who have successfully been removed and are recovering, but that's all anecdotal.
1. Percentage of patients who needed ventilation, got ventilation in good time, and recovered vs died.
2. Percentage of patients who needed ventilation, didn't get ventilation due to lack of resources, recovered vs died.
Then we'll know how much ventilators are helping.
I understand that prior to this pandemic, typical survival rates for patients who required invasive ventilation was in the region of 30%. 70% die even with ventilation.
I've also heard that of Covid-19 patients that require ventilation, 80% die even with ventilation. So it has a slightly lower survival rate than other illnesses.
The 30% survival rate means that 30% of patients are saved by ventilators. People who aren't dying without a ventilator aren't put on a ventilator, which is an extremely invasive medical procedure.
I'll be interested to see how well they can scale this up. Production functions are always dependent on the most scare component. Hopefully Tesla can leverage their already existing supplier base to easily source everything needed for this design.
This is pretty excellent. It is one of the first ventilator solutions that actually implements appropriate air sensors, a PEEP function and air flow monitoring. Hats off to the tesla engineers for throwing this together so quickly. It's pretty neat that so many car parts could be reused. I can imagine they are finalizing the software interface and optimizing the machining process to reduce the cut time on the custom manifold production. Again, awesome job guys!
The main criticism I see here is that without prolonged testing it's very possible for a piece of equipment like this to do harm to a person.
On the other side I see people saying that for those that can't get a ventilator and are going to die anyway, why not use it.
I'm curious if that category of patients exists though. With Covid are doctors able to make that call at any point? I've heard lot of Hail Mary treatments criticized because unlike in the movies there are many ailments where there's not really a clear point where someone's not coming back.
Anyone know if it's a common scenario with this where a doctor knows someone is def going to die but there is still time left to do meaningful treatment?
The FDA would take years to approve a new ventilator that was an old one with a new paint color. A new design like this would probably be approved for use in US hospitals around 2025 if they're lucky.
Might be useful sooner in a country with a more functional administrative state.
It shows that ventilation of covid-19 patients is not like ventilation of other patients.
I'll paste part of it here because I know some can't visit Facebook.
It's by Daniel Martin OBE, Macintosh Professor of Anaesthesia, Intensive Care Lead for High Consequence Infectious Diseases.
---everything below this point is a direct quote from Daniel Martin---
Ventilation
- Early high PEEP is probably not the right strategy and may be harmful. This is not ARDS in the early phase of the illness.
- Avoid spontaneous ventilation early in ICU admission as also may be harmful.
- There is clear microvascular thrombosis happening in the pulmonary circulation, which leads to an increased dead space.
- Also some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related, possibly inflammation related.
- Not many patients have reached extubation yet in London, re-intubation seems to be common. I highlighted our experiences of airway swelling / stridor / reintubation.
- Brompton are seeing wedge infarcts in the lungs on imaging, along with pulmonary thrombosis without DVT.
- Proning is essential and should be done early. Don’t just do it once. Threshold for many centres is a PF ratio of 13, but all agreed, do it even earlier.
- Early on in the disease, the benefit of proning lasts < 4 hours when turned back to supine, as the disease progresses into a more ARDS type picture, the effect is more long lasting.
- Many centres using inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with NO after 4-5 days.
- Generally people are using humidified circuits with HMEs.
- A very interesting thing they are doing at Georges is cohorting by phase of disease i.e. early, late, extubation / trachy. It involves more moving of patients but helps each team to focus on things more easily.
- Leak test before extubation is crucial, others are also seeing airway swelling.
- Wait longer than usual before extubating, high reintubation rates reported. Do not extubatne if inflam markers still high.
My conclusions from this are:
- Less aggressive PEEP strategy at the beginning of the disease and go straight for proning.
- Thromboembolic disease is prevalent, look for it. No one is sure about whether we should anti-coagulate everyone, this is probably too risky.
- An extubation protocol is needed immediately.
- We should consider using inhaled prostacyclin again (like we previously did) as it seems to be working early in the disease.
This looks promising. They're being smart to use their own supply chain as much as possible, but obviously things will get interesting when it comes to getting clearance to deploy the device. Even if the design can't be used in it's entirety, they may be able to fill part of the supply chain for other manufacturers.
One complaint - everyone keeps touching their damned masks. Keep your booger picker away from your face.
It's because their masks keep dropping when speaking. It's surprisingly hard to fit the mask in a way that you do not feel the urge to adjust it every now and then.
[+] [-] pdq|6 years ago|reply
These devices breathe air into patients lungs. They need to be manufactured in clean room conditions, with medical grade parts, not plumbing parts from a big box store. They must be designed and tested to ISO specifications. If this fails, the patient can die.
I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency.
The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
[+] [-] heleninboodler|6 years ago|reply
This effort they're doing really doesn't seem like they're treating it like a "Hackathon" project. They're putting real engineering resources behind it.
Whether or not they can produce something in time is still up in the air, but it seems to me Musk is attacking the problem from several different angles and hoping something works: he's purchased off the shelf BIPAP equipment and donated it (which turns out to not be as useful as hoped), he's got engineers homegrowing what appears to be a legit ventilator that may or may not get to volume production and/or certification in time, and he's helping established ventilator manufacturers with some of their manufacturing bottlenecks.
All three of these approaches are unlikely to be fruitful, but at a time when we're desperate and looking for quick innovation, it seems strange to dismiss people with the resources to try.
[+] [-] bArray|6 years ago|reply
If these patients receive no help, they die anyway. Given the choice between almost certain death or some experimental piece of hardware - give me the experimental hardware.
> I can't imagine any hospital or doctor careless enough to
> connect one of these to a patient, even in this current
> emergency.
I'm sure they will go through accelerated testing.
> The smarter idea is to ramp up existing proven designs,
> not reinvent the wheel and basically do a publicity stunt
> about your engineering talent.
Retooling has an enormous cost too (time and money) - yes the design will be proven but you won't nearly have the tools or expertise to implement them.
I'm not a Tesla fan-boy by a far shot, but I don't think they deserve this hate for what is clearly a good effort on their behalf.
[+] [-] natch|6 years ago|reply
It's been made very clear over the weeks here on HN how Tesla and SpaceX between them, with their overlapping engineering resources (Elon, for example) have deep experience with life support systems, at a level approved by NASA even. To diss their work as a hackathon project is pretty low.
It's also been widely discussed that this crisis requires us to try some new things, and think outside of the box.
Elon donates massive quantities of masks and various types of the specific breathing devices asked for by medical facilities, and then takes it to the next level, putting his company reputation on the line, and you call it... a publicity stunt.
But when Jack Ma donated masks with a lot of fanfare, you said...
>Kudos to Jack. ... this shows selfless entrepreneurship.
Seems like a bit of a double standard.
>The smarter idea is to ramp up existing proven designs, not reinvent the wheel
Reinventing the wheel has a long history of success. But that's another story. Closer at hand, they already addressed this in the video, and why they did not take the path you thought would be smarter.
Specifically, just to reiterate what was made very clear in the first few seconds of the short video, it would impact supplies needed by existing manufacturers.
[+] [-] kiba|6 years ago|reply
This is fundamentally a logistics project. Plus, they have access to Medtronic engineers, and as long as the FDA approve the devices, I have no problem with it.
[+] [-] product50|6 years ago|reply
"I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency."
This is utter BS. Imagine that you are in a situation where you are trying to ration lives by selecting who gets access to a ventilator. Won't you not use this device then too?
Please, for god's sake, appreciate and be thankful that we have such great companies in US trying to help our people out. For perspective, if you were in a developing country, like India etc., all you have is hope and no company will be stepping up (they just don't have the technical wherewithalls).
[+] [-] baybal2|6 years ago|reply
In the current situation, I doubt anybody will give any regard to your sentiment. Though, I myself will.
> The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
This is what China did. Ctrl-C, Ctrl-V, and knockoff ventilators began to fly off assembly lines in less than a month.
P.S. In other news, A VERY BIG THING that no news seem to be reporting. China has effectively banned nearly every medical export as of April 1 through enforcement of impossible to comply paperwork:
https://www.scmp.com/news/china/society/article/3077953/coro...
A man I know, who works at a medical clothing, and bedding factory, says that even such basic things that should not require any certification are now banned for export.
[+] [-] _ea1k|6 years ago|reply
Your last point is important, I think. Notably, Tesla & SpaceX have been working with Medtronic to provide solenoids that are apparently a bottleneck in Medtronic's production process. It wouldn't surprise me to hear that others are also working on supplies for existing production lines to help with more rapidly ramping production. I think this is more likely to be useful.
[+] [-] tashoecraft|6 years ago|reply
[+] [-] djoldman|6 years ago|reply
A choice between almost certain death and possible life isn't really a choice.
[+] [-] ComputerGuru|6 years ago|reply
[+] [-] fifteenforty|6 years ago|reply
This is not business as usual. We are already using various hacks to overcome the shortages, any improvement is worthwhile in the very short term.
[+] [-] gambler|6 years ago|reply
[+] [-] throwmamatrain|6 years ago|reply
[+] [-] dahfizz|6 years ago|reply
Those are not mutually exclusive. Yes, it would be great if we could produce more ventilators, but Tesla has no impact on "real" ventilator production either way.
This is obviously a PR piece. I see nothing wrong with a company trying to improve their brand's perception by trying to save lives.
[+] [-] xkjkls|6 years ago|reply
Partnering or giving resources to companies that already have approved ventilator designs would by far be more helpful.
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] m463|6 years ago|reply
If it becomes a battlefield medicine situation, what should happen?
I remember reading that during WW2 when there was no penicillin, nurses would inject milk I believe into patients, hoping it would stimulate an immune response and save the patient. Seems kind of risky, what are the ethics?
What should we do if we run out of ventilators?
[+] [-] nabla9|6 years ago|reply
Tesla partnered with Medtronic https://www.medtronic.com/us-en/index.html It seems that they also work as parts supplier for Medtronic.
[+] [-] emilfihlman|6 years ago|reply
Well, you can choose death, I'll choose life.
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] dmarchand90|6 years ago|reply
[+] [-] sschueller|6 years ago|reply
[+] [-] LittleNemoInS|6 years ago|reply
Less techie, more down to earth, they used wipe motors.
[+] [-] bonestamp2|6 years ago|reply
[+] [-] _ea1k|6 years ago|reply
[+] [-] ericzawo|6 years ago|reply
[+] [-] nabla9|6 years ago|reply
Tesla partnered with Medtronic https://www.medtronic.com/us-en/index.html It seems that they also work as parts supplier for Medtronic.
[+] [-] nsxwolf|6 years ago|reply
[+] [-] Spare_account|6 years ago|reply
1. Percentage of patients who needed ventilation, got ventilation in good time, and recovered vs died.
2. Percentage of patients who needed ventilation, didn't get ventilation due to lack of resources, recovered vs died.
Then we'll know how much ventilators are helping.
I understand that prior to this pandemic, typical survival rates for patients who required invasive ventilation was in the region of 30%. 70% die even with ventilation.
I've also heard that of Covid-19 patients that require ventilation, 80% die even with ventilation. So it has a slightly lower survival rate than other illnesses.
[+] [-] adrianN|6 years ago|reply
[+] [-] xkjkls|6 years ago|reply
[+] [-] zebrafish|6 years ago|reply
[+] [-] salvagedcircuit|6 years ago|reply
[+] [-] gruez|6 years ago|reply
[+] [-] DubiousPusher|6 years ago|reply
On the other side I see people saying that for those that can't get a ventilator and are going to die anyway, why not use it.
I'm curious if that category of patients exists though. With Covid are doctors able to make that call at any point? I've heard lot of Hail Mary treatments criticized because unlike in the movies there are many ailments where there's not really a clear point where someone's not coming back.
Anyone know if it's a common scenario with this where a doctor knows someone is def going to die but there is still time left to do meaningful treatment?
[+] [-] gok|6 years ago|reply
Might be useful sooner in a country with a more functional administrative state.
[+] [-] panpanna|6 years ago|reply
Any people working with real medical ventilators care to comment on this?
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] detaro|6 years ago|reply
[+] [-] Hamuko|6 years ago|reply
[deleted]
[+] [-] DanBC|6 years ago|reply
They've clearly got involvement with existing ventilator manufacturers.
Are they talking to doctors in ITUs? Here's a recent Facebook thread from people involved in London's new hospital: https://www.facebook.com/permalink.php?id=103930280957826&st...
It shows that ventilation of covid-19 patients is not like ventilation of other patients.
I'll paste part of it here because I know some can't visit Facebook.
It's by Daniel Martin OBE, Macintosh Professor of Anaesthesia, Intensive Care Lead for High Consequence Infectious Diseases.
---everything below this point is a direct quote from Daniel Martin---
Ventilation
- Early high PEEP is probably not the right strategy and may be harmful. This is not ARDS in the early phase of the illness.
- Avoid spontaneous ventilation early in ICU admission as also may be harmful.
- There is clear microvascular thrombosis happening in the pulmonary circulation, which leads to an increased dead space.
- Also some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related, possibly inflammation related.
- Not many patients have reached extubation yet in London, re-intubation seems to be common. I highlighted our experiences of airway swelling / stridor / reintubation.
- Brompton are seeing wedge infarcts in the lungs on imaging, along with pulmonary thrombosis without DVT.
- Proning is essential and should be done early. Don’t just do it once. Threshold for many centres is a PF ratio of 13, but all agreed, do it even earlier.
- Early on in the disease, the benefit of proning lasts < 4 hours when turned back to supine, as the disease progresses into a more ARDS type picture, the effect is more long lasting.
- Many centres using inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with NO after 4-5 days.
- Generally people are using humidified circuits with HMEs.
- A very interesting thing they are doing at Georges is cohorting by phase of disease i.e. early, late, extubation / trachy. It involves more moving of patients but helps each team to focus on things more easily.
- Leak test before extubation is crucial, others are also seeing airway swelling.
- Wait longer than usual before extubating, high reintubation rates reported. Do not extubatne if inflam markers still high.
My conclusions from this are:
- Less aggressive PEEP strategy at the beginning of the disease and go straight for proning.
- Thromboembolic disease is prevalent, look for it. No one is sure about whether we should anti-coagulate everyone, this is probably too risky.
- An extubation protocol is needed immediately.
- We should consider using inhaled prostacyclin again (like we previously did) as it seems to be working early in the disease.
[+] [-] yoda_sl|6 years ago|reply
[+] [-] toomuchtodo|6 years ago|reply
[+] [-] vernie|6 years ago|reply
[+] [-] dkdbejwi383|6 years ago|reply
[+] [-] Beltiras|6 years ago|reply
[+] [-] m4tthumphrey|6 years ago|reply
[+] [-] vorpalhex|6 years ago|reply
One complaint - everyone keeps touching their damned masks. Keep your booger picker away from your face.
[+] [-] ha4fsd3fas|6 years ago|reply