Bioforge OxySaver

Currently, health systems are under huge pressure with hospitals in many LMICs being unable to provide oxygen to covid patients due to logistical constraints and limited supplies. There is an increasingly desperate situation for hospitals, patients, and their families. 

Bioforge OxySaver is a device that conserves the oxygen by only releasing it during inhalation of the patient, thus increasing the oxygen supply in every cylinder at least twofold, and reducing the technical and logistical issues of refilling a cylinder by half. Our rapidly manufacturable device can be easily added to existing cylinders and regulators without hampering oxygen flow to patients. 

By increasing the life of current oxygen supplies, the device would be reducing costs, helping to cope with the ongoing crisis, and aid all future patients suffering from illnesses requiring supplemental oxygen, not just in Bangladesh but in many LMICs.

High-pressure oxygen can be critical for a patient’s survival. At present, half a million people require supplemental oxygen daily in low and middle-income countries due to the pandemic. 

Oxygen manufacturing is a capital-intensive process, where manufacturers supply hospitals and industries directly. Given the limited access of direct oxygen lines to hospitals in LMICs, patients often receive oxygen, using up to 30 liters in a minute, from cylinders that require daily refilling.

In India, the shortage of oxygen resulted in thousands of preventable deaths. In our local communities, there's already a 40% increase in demand for oxygen with industries and oxygen manufacturers diverting supplies to hospitals. However, the logistical challenges of refilling and distributing cylinders in time remain. With less than 50% of our country’s cylinders being available in areas outside the two major cities, the burden of refilling is even higher. The poor infrastructure and overburdened healthcare workers add up to the existing crisis.

More than half of the oxygen from cylinders is then wasted during its application to patients. The OxySaver provides a practical solution that instead conserves this oxygen, doubling each cylinder's oxygen supplies, thereby decreasing the burden of preventable deaths.

The Bioforge OxySaver is a demand oxygen delivery system (DODS). It is designed to let oxygen be released from the cylinder only during inhalation and so conserve oxygen which is otherwise lost using continuous flow oxygen, during exhalation, and when a patient is at rest. The device can be connected with oxygen cylinders and also with hospital oxygen supply lines. Bioforge OxySaver works with pressure sensors that rely on the minute pressure changes that happen when a patient breathes in and out. An additional nasal cannula is used to detect this change in pressure. These are connected to a sensitive pressure sensor with a microcontroller controlling a valve to release the oxygen as a patient inhales. Our device also has multiple safety features to ensure the patient will get the required supply of oxygen. This combination of efficient technology and safety has not previously been available in Bangladesh or other LMICs and is now critical due to the sudden disproportionate need for oxygen in the pandemic.

Nineteen low and middle-income countries (LMIC), are deemed at a high risk of running out of oxygen during demand surges at the peak of the pandemic, placing its population in a life-threatening situation. The Bioforge OxySaver is aiming to provide new technology to all such LMICs, making up 80% of the world's population, and any low resource settings to avert the possible threat of lives lost due to oxygen shortages both in COVID-19 and for any future health adversities requiring supplemental oxygen. Countries including Nepal, Costa Rica, Philippines, Argentina, Colombia, South Africa have all seen a rise in the demand for medical oxygen, but with the limited resources to meet the demands along with unfavorable conditions such as poor infrastructure and poor vaccination rates, there is a very high risk of exponential increases in COVID-19. 

With unanticipated demand increases in India, neighboring countries such as Nepal and Bangladesh are faced with restrictions on importing oxygen from them and have limited means to supply their own increased demand in oxygen and its supporting equipment. 

Approaching the times ahead, our device is aimed to provide aid to all patients suffering from COVID-19, that require supplemental oxygen but are unable to receive it due to oxygen constraints in their country. As such we have collaborated with frontline COVID-19 doctors and with Linde Bangladesh, who supplies over 90% of Bangladesh’s oxygen requirement, to design the Bioforge OxySaver. With their input, we have designed a device that is low cost, can be used with current cylinders and oxygen lines, and is also easy to use for patients. 

The Bioforge OxySaver virtually doubles oxygen utilization, without diminishing oxygen supply to a patient, thus reducing the logistical nightmare of refilling a cylinder. Financial constraints which result in disparities in the treatment of patients are also reduced, facilitating the equitable distribution of oxygen. This would help reach out to the vast majority of people living across our country and other LMICs, where patient-to-bed ratios are so high resulting in low accessibility of oxygen treatment, and thus oxygen starvation.

We are addressing difficulties in providing sufficient oxygen to patients in resource constraint regions. The solution proposes a demand oxygen delivery system that only provides oxygen on inhalation, allowing oxygen supplies to last longer. This provides necessary tools to primary healthcare workers in the frontlines to effectively respond to disease outbreaks requiring medical oxygen, especially where cylinders are prevalent. This technology is also applicable at the last mile for the health security of people beyond the pandemic. This would be critical in serving patients in settings where limited oxygen supplies and resources result in preventable mortality.

The Bioforge OxySaver prototype is ready, with several devices developed for use in clinical trials. We have prepared all documentation for medical device approval following the Government of Bangladesh guidelines. We will be partnering with Dhaka Medical College and Hospital (DMCH) and Bangladesh Medical College (BMCH), both leading hospitals in Bangladesh for the battle with the pandemic. Our oxygen resources are constrained and case numbers are increasing. We are going through a rapid development where we are entering clinical trials to test the safety and efficacy of the device under various conditions. We are also preparing for a quick progression to manufacturing once the trials are complete, and it is evident that this technology is effective and safe.

DODS devices already exist but have many shortcomings when placed in resource-constrained settings. To tackle these challenges, we have aimed to design a device fully adapted to such settings that require oxygen conservation the most. 

As the production of biomedical equipment is uncommon in our regions, we have taken into consideration the lack of technical knowledge that may be present in manufacturers. Thus, we have designed a device with easy-to-access manufacturing technologies. It is also easy to use for healthcare workers and for patients using cylinders at home. 

There is a financial burden already faced by many hospitals and patients in such countries, and thus we have built the device using cost-effective parts, to be priced at under $100 per unit. 

Our target population exists in regions where power inconsistencies are common.  Therefore the Bioforge OxySaver uses an open valve that doesn’t fail to trigger in case of power failures, prioritizing oxygen delivery to the patient. 

The device, once deployed, will create a change in each country by making them more independent in their own oxygen resources and creating more accessible healthcare for oxygen treatment. We will ensure that we verify the full functionality of our device through vigorous testing before use for those most in need.

Currently in clinical trials, our solution is going to be tested on 60 patients in Dhaka Medical College and Hospital (DMCH). Once we are done with the trials, our solution will go into mass manufacturing and can serve upto 5000+ to 10000+ patients in one year. And within the next five years, we are expecting the number to rise exponentially, upto 100000+ people in Bangladesh and other countries facing challenges in providing oxygen supplies to their patients.

We will be measuring progress through the following indicators:

• Approval of clinical trials and acceptance of results 

• Duration of oxygen supply in cylinders (longevity)

• Number of patients served

• Reduced mortality (based on clinical trials)

• Acceptance of technology (feedback by doctors using the device)

• Adoption of technology and feedback by hospitals the technology is used in

• Revenue generated

• Financial benefit for hospitals (less oxygen wasted)

• Financial benefit for patients at hospitals and at home (fewer cylinder refills)

Numbers for full-time staff: 5

Part-time staff: 7

Advisors (Doctors): 5

Advisors (Technical Experts): 4

Bioforge’s founder is Dr. Dewan Choudhury, a doctor, and leader who has seen the difficult choices people have to make between life and money during his medical internship. Through those experiences, he has been charged with a drive to save as many lives as he can and has built a team where we all share a drive to make healthcare accessible to all. Our team members have degrees from different sectors consisting of two members with a doctor of medicine degree, a respiratory specialist, five members with engineering and electronics degrees, two members experienced in software development, two members with experience in research, and also one member with a degree in business administration with experience of over 15 years. We are also guided by experts in the field of biomedical technology such as Dr. Rabbani, and also by Dr. Alam, a forefront expert in medical care in one of the leading covid hospitals. Our team works with a passion that none can compare to. Driven by the collective goal and what Bioforge stands for, this team never hesitates to come forward and give their everything to find solutions to help save more lives. Even in the pandemic, team members are contributing to their maximum levels to help get the OxySaver in the market as fast as they can, putting their lives at risk, doing so without rest around the clock.

Our company is highly conscious that diversity builds strength and this is reflected in our leadership team with both male and female members coming from different faiths and educational backgrounds. This leadership team ensures that we remain gender and race-neutral in our efforts to recruit any members of the team. For example, HR removes religious backgrounds and photographs when screening through resumes. We have a target to ensure equal representation of both sexes at all levels of the organization.

As a leading, globally recognized organization, MIT would be an amazing stakeholder for our project to build awareness for its use worldwide. Being a winner of last year’s challenges, we clearly understand how MIT Solve and its resources in providing us direct and indirect mentorship has helped us accelerate our technology, increased our recognition on a global platform and helped open up opportunities with similar organizations in the field.

When we deploy the device, we would want to reach out to many countries alongside our own. Gaining approval from MIT Solve would provide us with the credibility to enter these countries and allow faster adoption of the technology by doctors, nurses and patients alike. The program prizes would also greatly financially benefit the deployment of the product and sourcing of technology for its mass manufacture. This would help us move rapidly in our process to hand healthcare facilities with the ability to provide more efficient oxygen treatment to its patients with limited oxygen supplies.

We seek financial support from MIT Solve. We know that being part of the community means being in close contact with experts, leaders, and game-changers that can help build the organization Bioforge aspires to be. 

Public Relations aid is required so that we can increase awareness of the technology as it is a fairly new concept in our neighboring regions. We aim to market to not only our country but all our target countries that will require assistance so that the solution may be properly implemented. Being part of the MIT solve class greatly boosts public impression and helps in the adoption of our device in international markets.

After approval of the device, manufacturing and distribution will take place. In order to deploy the device in countries in need, we require support from international individual organizations for distribution. Countries also have individual sets of rules and procedures for medical device adaptation, we also require support to achieve this efficiently.

United Nations organizations such as WHO, UNICEF, UNDP, and UNHCR all committed to providing liquid oxygen and devices such as oxygen cylinders and concentrators to countries in their time of need, would be great to collaborate with. It would raise awareness and help us reach countries on a global scale as well as improve the distribution and adaptation of our device. 

We would also like to work with local impact-based organizations of the country in which we want to deploy the device so that their efforts can directly impact the local communities.

Medical oxygen is an essential medicine in the treatment of numerous diseases. It can help save the lives of people in need and battle surges of future pandemics. Our solution will be especially useful in refugee camps with limited oxygen supplies and high population density. In such scenarios, disease outbreaks occur more rapidly with fewer medical resources available for patient treatment. In the case of our solution, we would be increasing the oxygen resources of the Rohingya camps based in Bangladesh. This is essential in the case of COVID outbreaks as their remote locations would mean that transport of oxygen to these areas would be difficult. The limited healthcare facilities would not be receiving oxygen fast enough to treat all their patients. Our device will ensure such a scenario does not occur and no individual dies from oxygen starvation.

One of the key life-saving products that saw a recent shortage at health facilities in India, resulting in thousands of preventable deaths, is the availability of medical oxygen. This was not only caused by a limited supply of the product in oxygen pipes of hospitals but also in logistical hurdles of transporting it for refills in time to cylinders that are prevalently used in many countries of the world.

In the context of the current COVID-19 pandemic, oxygen is a life-saving tool for the treatment of patients that develop complications from the infection, such as pneumonia, hypoxemia, and acute respiratory distress. This is especially true for patients with comorbidities such as Tuberculosis (TB) and HIV. Patients were most likely to be hospitalized and their clinical symptoms more likely to progress to a critical stage. 

A total of 33 studies have shown that TB is a high-risk factor for COVID, with Liu et al. (2020), reporting that COVID patients with TB made up 78% of cases that reached a severe to a critical stage. This is a life-threatening sentence for many living in LMIC countries, as 10 million people developed TB in 2019, amongst which 44% were from South-East Asia. HIV-positive individuals, who are much more likely to also have TB, were also at a higher risk of mortality from COVID complications. With over 5.8 million people infected with HIV in the Asia-Pacific countries, it becomes another big risk factor for these regions. 

Both diseases also have a staggering correlation to low-income populations, where those already unable to financially seek medical help, are overburdened with costs for treatment of their conditions. It is exactly these people that our device would be able to reach by making oxygen treatment accessible during a crisis, where they are more likely to become hospitalized for the need of supplemental oxygen and less likely to have the funds to pay for their treatment.

By conserving oxygen, and increasing oxygen supplies, the Bioforge OxySaver will increase the equitable distribution of oxygen and its affordability. Treatment disparities caused in such crises, especially due to the financial and logistical causes, will be greatly reduced by making oxygen available for these vulnerable individuals and for any COVID-infected individual needing treatment. 

Our solution will go beyond the pandemic and provide health workers and service users with extended supplies of oxygen and reduced logistical strains for long-term treatment of illness requiring oxygen. It will also be of use for any future pandemic situation that may arise, once again disproportionately affecting low resource countries, and less privileged individuals already inflicted with these life-threatening conditions. 

References:
Liu, Y., Bi, L., Chen, Y., Wang, Y., Fleming, J., Yu, Y., ... & Cheng, M. (2020). Active or latent tuberculosis increases susceptibility to COVID-19 and disease severity. MedRxiv