I will be posting any relayed cases of use of the EMCrit CPAP set-up here:

from an ED Doc 3-25-20

This is such a game changer in my shop. I think it will truly save lives and unnecessary tubes/bed allocation.

We used this today successfully on COVID Pt in our ED, with short extension tubing, to limit dead space and increase comfort of fit, between side port adapter and ILI filter.

Initially, 80% on RA, 95% with NRB/NC but with tachypnea and flow discomfort.  After switching over to the closed circuit CPAP set-up, sats rose immediately to 99-100%.  Well tolerated and stayed on for several hours with normal ABG at 2 hours.

ICU wanted to switch over before going to final destination.  Switched to HFNC and immediately sats dropped into 80’s without PEEP.  Sats improved with increased HFNC>50 L/min(kind of defeats the purpose of closed circuit) to reintroduce some PEEP.

Any experience on how long peeps can stay on this circuit, without significant leaks, and when they do occur, where are the most vulnerable connections?  I would think goal would be to leave this on until arrival at final destination, which would be closed Circuit BiPap or helmet CPAP.  Anyone doing helmet CPAP?  How many of these circuits are sites going through in a day?

Thanks for this game changer!  Hoping to keep a lot of hypoxic, PEEP dependent peeps from unnecessary intubations.

Only challenge is getting ICU on board with leaving them on this until they reach their final destination. They are concerned about training their staff and circuit failures.

As soon as Pt put on HFNC, sats dropped. ICU was then pushing to intubate, but we were able to bring sats up with 50 L/min HFNC. Went to ICU on HFNC, but with increased aerosol.

Ideally would move patient to floor , step-down, for continued closed circuit CPAP through vent or CC BiPap upon arrival.

FYI, 2 hour ABG on CCC was 7.4/31/104. Dropped PEEP a little, and no change in condition. Patient tolerated 15L/4L well.