Experts caution on reuse of Ambu bags in ARDS cases during COVID-19 treatment

Experts caution on reuse of Ambu bags in ARDS cases during COVID-19 treatment

Shardul Nautiyal, Mumbai
Wednesday, April 29, 2020, 08:00 Hrs  [IST]

Experts in the healthcare field have cautioned that reuse of Ambu bags in acute respiratory distress syndrome (ARDS) cases during COVID-19 treatment might pose serious health risks to healthcare workers and patients as they are a major source of infections in hospitals.

These experts and other healthcare activists therefore have urged the Union health ministry to use disposable Ambu bags instead of reusable Ambu bags to avoid COVID-19 infection. Especially mechanically ventilated patients with underlying disease who are hospitalized in ICUs for prolonged periods are considered as being under increased risk.

“It is recommended that disposable bags should be used based on WHO guidelines considering the fact that about 5 lakh doctors and 4 lakh paramedics are directly exposed to the COVID-19 pandemic as of today at the point of care,” revealed Abhay Pandey, national president, All Food and Drug Licence Holder Foundation (AFDLHF).

Ambu bag is a manual resuscitator or self-inflating bag recommended as the first-line device for emergency artificial ventilation for critical care patients and are thus used not only throughout hospitals but also in out-of-hospital care venues by fire-fighters, paramedics and outpatient clinic personnel.

But these days, the use of reusable Ambu bags in the treatment of COVID-19 patients cannot be ruled out. Therefore, in view of its seriousness, healthcare activists have voiced their concern to the Central Government informing that disposable Ambu bags should be used instead of reusable Ambu bags.

A bag valve mask, sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or self-inflating bag, is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.

Ahmedabad-based Pharmaceuticals Consultant Dr Sanjay Agrawal explained, “COVID-19 is essentially a respiratory ailment. It complicates some of the pre-existing health conditions in patients leading to death. Severe injury to the lung tissue can result in ARDS in patients with COVID infection, which can further precipitate septic shock”.

ARDS develops in 42% of patients presenting with COVID-19 pneumonia and 61-81% of those requiring ICU care. The respiratory rate and SpO2 are two important parameters for judging patients clinical condition and allowing early recognition of ARDS. SpO2 stands for peripheral capillary oxygen saturation which is an estimate of the amount of oxygen in the blood.”

Death from COVID-19 ARDS is due to respiratory failure (53%), respiratory failure combined with cardiac failure (33%), myocardial damage and circulatory failure (7%). COVID-19 ARDS is a predictable serious complication of COVID-19 that requires early recognition and comprehensive management.

Besides this, compounding the problem further, there is no concrete number of ventilators that India has in its hospitals. But estimates are that there is one ventilator for every thousand patient. To tackle the shortage, Government has also set up 723 COVID-19 hospitals, two lakh isolation beds, 24 thousand ICU beds and 12, 190 ventilators in the country.

Echoing similar views, Pharma Consultant Kaushik Desai said, “All likely sources including Ambu bags should be dealt with utmost care to ensure that these accessories does not further contribute in alleviating the infection at the point of care.”

India banned the export of ventilators only on March 19, 2020 by when the country had recorded 173 cases of novel coronavirus infection. The same day, the export of masks and overalls (protective equipment) were also prohibited.

Hospital associated infections (HAIs) due to invasive medical devices in the ICUs are a major threat to patient safety. Device-associated infections (DAI), particularly ventilator-associated pneumonia, central venous catheter associated bloodstream infections and catheter-associated urinary tract infections pose the greatest threat to patient safety in the ICUs.