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Airbreak.dev: Jailbreak your CPAP machine to turn them into ventilators
- dimgl 7y agoThis is very cool. I was wondering the other day if my CPAP machine (same model) would be capable of doubling as a ventilator and I'm surprised that someone has already thought of this and provided a solution.
- rootusrootus 7y agoI've got exactly that model as well. There are probably 10s of millions of them in use in the US. Really cool to see someone hack them, but I can't say that I will be doing that with mine :).
- tcbawo 7y agoNot a doctor. A major issue with using this type of CPAP machine on a Covid-19 positive person is the high amount of aerosolized virus particles it exhausts. Anyone using this should be extremely careful and know what they're doing. That being said, doctors in many countries are using positive air pressure machines with an air-tight helmet/bag with filtered exhaust.
- Tepix 7y agoThat's what it says right there on the page already: "Additional equipment like viral filters are also required."
- minikites 7y agoSo it's okay to show someone how to make something extremely hazardous as long as you include a flimsy nonspecific disclaimer?
- shijie 7y agoI believe so, yes. I like to think people can make reasonable decisions with information they are provided
- minikites 7y agoIf people can make reasonable decisions all of the time, why do we even have laws? Reasonable people wouldn't violate them anyway.
- folkhack 7y agoThis is pandering to an extreme situation in order to make a case... I think anyone on HN will acknowledge that people are on a scale from "not reasonable" to "very reasonable". You're pushing the comment you're responding to over to a binary point of view. I don't believe in good faith that shijie meant "all of the time" when they said "I like to think people can make reasonable decisions with information they are provided". To push their statement to "all of the time" while bringing the ethics of law into this conversation seems disingenuous to the safety/disclaimer concerns you originally called into question. Personally, I found the disclaimer on the airbreak.dev site to be very clear and appreciated it was on the front-page directly following the product summary. It is clear to me that this is an "in-development" project that is not ready for real-world deployment yet - they're being quite clear/transparent with these facts.
- patmorgan23 7y agoActually yes(not that this is particularly dangerous) . It happens litteraly all the time. Ever seen all those "don't try this at home" disclaimers? Also someone published a book called "the anarchist cook book" on how to make rudimentary explosives and manufacture illicit substances such as LSD. You can find a pdf of it with a quick google search.
- derrick_jensen 7y agoBoth of those have fairly obvious consequences. I can definitely see people using this and not recognizing it can put other people in harms way.
- cibomahto 7y agoMt. Sinai developed a procedure for using these safely in a clinical setting, by using an alternate patient circuit with viral filters to capture the aerosolized particles: https://health.mountsinai.org/wp-content/uploads/sites/14/2020/04/NIV-to-Ventilator-Modification-Protocol-v1.02-for-posting.pdf https://health.mountsinai.org/wp-content/uploads/sites/14/20...
- fortran77 7y agoWhat's scary is that CPAP machines are allowed on airplanes. If they really aerosolize virus particles, maybe they shouldn't be.
- dpeck 7y agoAt least on Delta flights they’re not allowed to be used, I’m not sure if the same policy exists on other airlines. Edit: I was wrong, see below
- reaperducer 7y agoI'd be very surprised to see any airline restrict the use of a medical device onboard. The manual that came with mine states that airlines are required to let you use it, and the manufacturer sells an airline-friendly battery pack. Do you have a link to Delta's policy on this?
- dpeck 7y agoMy mistake, I was wrong. They allow use, but it has to have its own power supply https://www.delta.com/us/en/accessible-travel-services/assistive-devices-medication https://www.delta.com/us/en/accessible-travel-services/assis...
- cameldrv 7y agoThis would seem to be because they don't want to be held to providing medical grade reliability of electricity to the seat.
- fortran77 7y agoI've sat next to people using them on Delta and United. Of course, I'm not without empathy for people who depend on them. But if a person has a viral infection that can be spread through droplets, this can be a very dangerous situation. If I'm ever in this situation again, I'll ask to be reseated. If they can't do that, I'm not sure I'd want to fly.
- SkyPuncher 7y agoIf you're using this where non-COVID patients could be exposed (e.g. at home) this is a very important consideration. In a hospital setting (aka an emergency), it's less of an issue. The situation that would warrant this would likely also warrant full PPE just to enter a unit or building.
- DanBC 7y ago> it's less of an issue. The situation that would warrant this would likely also warrant full PPE just to enter a unit or building. Isn't it still important not to spray covid everywhere? See for example this post: https://emcrit.org/emcrit/covid-airway-management/ https://emcrit.org/emcrit/covid-airway-management/ > Critical Note: If you use the vent for preox, you MUST disconnect the vent circuit proximal to the viral filter before removing the mask. Otherwise, COVID will be sprayed all around the room!!!!! See Triple C below. {EDIT: genuinely don't know why this got downvotes.}
- dontparticipate 7y agoMessing with vents if you don't know what you're doing sounds like a sure fire way to kill yourself.
- renewiltord 7y agoI think the risks are overstated. Probably not anywhere near surefire.
- schuetze 7y agoAgreed. BiPaP to ventilator already seemed like a somewhat questionable transformation, and now we're going CPAP ----questionable software hackery ----> BiPaP --- questionable hardware hacking ---> Ventilator This is hubris. Ventilators are not iPhones circa 2010. It's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks. A significant portion of medical device RnD is related to creating technology that is hard to misuse and won't result in accidental death, and I just don't see that here.
- mschuster91 7y ago> A good portion of medical device RnD is related to creating technology that is hard to misuse and result in accidental death, and I just don't see that here. The people relying on these hacks would be definitely dead without the hacks, that is the point. Even if the chances of this working successfully are only 10%, you just saved 10% of the patients compared to 0%.
- cjbprime 7y agoI mean, it's also irresponsible for societies to have fewer respiratory therapists and ventilators than are needed to support their patients, but here we are.
- birdyrooster 7y agoAgree with your sentiment. Now to nitpick: the first iPhone jailbreak was achieved days after the iPhone was released way back in July 2007. Source: https://www.cultofmac.com/192850/the-history-of-jailbreaking-feature/ https://www.cultofmac.com/192850/the-history-of-jailbreaking...
- pkaye 7y agoThis is an informative video in what is involved in designing ventilators. https://www.youtube.com/watch?v=7vLPefHYWpY https://www.youtube.com/watch?v=7vLPefHYWpY
- dfsegoat 7y agoNot a doctor. But I am seeing growing evidence that ventilators are overused potentially. From ref [1]: > But as doctors learn more about treating Covid-19, and question old dogma about blood oxygen and the need for ventilators, they might be able to substitute simpler and more widely available devices. and > "In a small study last week in Annals of Intensive Care, physicians who treated Covid-19 patients at two hospitals in China found that the majority of patients needed no more than a nasal cannula." 1 - https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ https://www.statnews.com/2020/04/08/doctors-say-ventilators-...
- sod 7y agoThat's what I heard as well from https://www.youtube.com/watch?v=6Dwcfye7_LQ https://www.youtube.com/watch?v=6Dwcfye7_LQ Maybe not overused, but wrongly applied. He cites a doctor from new york in the video and two sources in the video description.
- imhoguy 7y agoMore sources: https://time.com/5818547/ventilators-coronavirus/ https://time.com/5818547/ventilators-coronavirus/ https://www.telegraph.co.uk/global-health/science-and-disease/intensive-care-doctors-question-overly-aggressive-use-ventilators/ https://www.telegraph.co.uk/global-health/science-and-diseas...
- jon_elbrook 7y agoventilators don't just pump air. they also monitor and control the amount of air, and beep when something is wrong. plus a bunch of other features...
- c0brac0bra 7y agoCPAPs control the amount of air by measuring backpressure AFAIK.
- takk309 7y agoExactly, I would not like being hooked up to a machine that could overinflate my lungs without sounding any alarms.
- CydeWeys 7y agoWell good thing a CPAP won't do that to you then, for obvious reasons.
- tibbydudeza 7y agoThat is why they are limited to deliver only 20cmH2O (water pressure). Even at that high setting it does not affect your lungs ... the purpose of a CPAP is keep your upper airways open i.e back of your throat ... you still need to breath on your own.
- sudosysgen 7y agoSo do CPAP machines, though.
- rootusrootus 7y agoA typical modern CPAP also takes measurements, and makes limited adjustments based on what it sees. It doesn't just pump air. Not that it's as capable as a real ventilator, but it's not just a simple air pump, either.
- hangonhn 7y agoYou also need to warm and humidify the air because ventilators are inserted past the part of your respiratory system that does that.
- draw_down 7y agoNothing can possiblye go wrong.
- fowkswe 7y agoAlso worth understanding that a ventilator is not always the best option - there have been findings recently that a tactic called 'proning' is often enough to increase blood oxygen: https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...
- w0mbat 7y agoTLDR; They treated patients who presented with low blood oxygen by lying them on their belly or side and giving them oxygen through a nasal tube. No machine required. In many cases it worked perfectly.
- deleted 7y ago[deleted]
- DanBC 7y agoHere are two useful videos about proning to explain why it works: https://twitter.com/libbyg9/status/1243813444689821696?s=20 https://twitter.com/libbyg9/status/1243813444689821696?s=20 https://www.youtube.com/watch?v=FS4t5w1eCYw https://www.youtube.com/watch?v=FS4t5w1eCYw Proning can be done to intubated patients too.
- bhartzer 7y agoJailbreaking the CPAP machine might not be necessary. From what I understand, a CPAP, in certain circumstances, can be given to someone who has 'milder' COVID-19 symptoms. That would then free up a ventilator so the vent can go to someone who has more severe symptoms.
- favorited 7y agoThe CPAP jailbreak community was eye-opening when I first learned of it. I never expected something like that, but with the draconian policies it's not surprising. For example, my CPAP has a CDMA radio inside, which transmits usage data back to the manufacturer & my doctor. Insurance won't pay for it unless the machine tells them I'm using it – so a medical device company has a record of when I sleep and wake, which is mildly unnerving. Edit: I think sleepyhead[0] was the biggest project when I started looking into it, but it isn't under active development anymore. Apparently forked to OSCAR[1]. [0]https://gitlab.com/sleepyhead/sleepyhead-code https://gitlab.com/sleepyhead/sleepyhead-code [1]https://gitlab.com/pholy/OSCAR-code https://gitlab.com/pholy/OSCAR-code
- reaperducer 7y agoOnce the insurance has finished paying for it (eight months in my case), you can disable the radio. Some doctors (mine included) prefer getting your data off the memory card when you visit the office, rather than downloading it from the internet anyway. The radio has to be optional for people whose beds are in places with unreliable or no cellular service (high up in buildings, in basements, fringe areas, etc...)
- rootusrootus 7y agoIIRC the data sent over the cellular connection is just summary information, it doesn't contain a full dump of the detailed measurements that will be stored on the SD card.
- favorited 7y agoI actually already have the option of disabling it (it has an airplane mode), but it spams me to turn the network back on. I just kinda gave in, to be honest. They're going to get the data anyway, and it is valuable to the doctor. I just don't need the device manufacturer to be storing it.
- surge 7y agoYeah the radio is there as an added convenience so you don't have to keep a log and send it in for several months as evidence of usage. This is the fallback for those without radio, and its easy enough to put it in airplane mode. That said, Resmed provides a nice enough interface where you can track your sleep habits. To be fair it seems all they seem to track is how much you sleep each day, not when, where, etc. So they only collect data on usage, and also they feed some of the data (like detected apnea incidents) to my sleep clinic for review. The medical supply company stops providing the data to my insurance after the probationary period is up. Remember, your insurance already has access to a great deal of your medical information already, this isn't that invasive, and CPAP's are expensive and take a while to adjust to, so I understand why they want to ensure people are using them and they're working if its going to be purchased.
- stcredzero 7y agoHere's what you should really know before you design a ventilator, by someone who works for a medical equipment company. https://www.youtube.com/watch?v=7vLPefHYWpY https://www.youtube.com/watch?v=7vLPefHYWpY
- alepacheco 7y agoReally good video right there!
- quickthrower2 7y agoThe Indian design with the android phone looks very interesting - I hope that can be shared and mass produced, assuming it does a decent and safe job.
- stellar678 7y agoI think the whole point of hacking a CPAP is that it's already got the control and sensors that could allow a doctor to use it without injuring a patient. It's just a matter of exposing that via the software.
- ac130kz 7y agoCPAPs are known to be very closed systems, I remember a couple of articles about handy SleepyHead analysis software. If anyone interested, it was forked - new name is OSCAR.
- Isamu 7y agoIt’s true, it is mostly a software change to upgrade a cpap into a bi-level device more like a ventilator. The barrier is really about procurement, and if they are proposing to reuse devices then it is all about shipping them to a location to be cleaned and tested, modified if necessary, repacked and shipped to a destination with new masks, hoses, and proper updated manuals.
- tibbydudeza 7y ago"The breath extension replaces the function at 0x80bb734" It sounds what Naughty Dog did to get RAM on the PSX for Crash Bandicoot ... they grabbed memory already allocated by the Sony runtime libs and would use it if it not do anything bad. A crashing game console is not a ventilator but a good hack nonetheless.
- gowld 7y agoIt's a standard technique -- binary patching. https://en.m.wikipedia.org/wiki/Patch_(computing) https://en.m.wikipedia.org/wiki/Patch_(computing)
- IdoRA 7y agoThere is a reasonable chance that this will not be as useful as the team hopes: 1) They are increasing maximum pressure and pressure rate changes beyond the built-in design parameters. If these new parameters are outside what the engineering requirements document spec, these changes are a problem in seeking EUA. 2) In regulatory affairs, authorized, cleared, and approved have very specific (and enforceable) meanings. If someone is loose with how they use these words, it suggests they don’t have someone with regulatory experience involved (a negative sign). The earlier the team can engage with someone with regulatory experience, the better.
- reaperducer 7y agoThese are not normal times, and I can certainly see a doctor with tinkering skills modding his office's CPAP stock in order to save lives.
- gowld 7y agoNot likely a doctor in a US hospital. Too much liability risk.
- Ericson2314 7y agoThe idea is manufacturers don't want to loose money and do this stuff themselves, so somebody donates their time to bring this hack to the FDA, and then the hospitals can use it.
- jschwartzi 7y agoThe problem is that high pressures can cause barotrauma. So you might end up increasing PEEP beyond what a patient's lungs can survive, and because you're using a CPAP machine instead of a ventilator there's not really any facilities to measure pressures that high. Or there are but they were never characterized because the machine doesn't measure pressures that high. And because they were never characterized you may not actually be delivering the pressure that the machine says you're delivering. So this is pretty crazy. The other thing ventilators typically include is pressure alarms and high pressure limits. Under routine use the high pressure limits keep you from popping patient lungs in volume-controlled modes. A pressure-controlled mode like BiPAP may be okay in this case since it provides those limits. The downside of pressure-control is that the patient's lung compliance and alveolar recruitment may change, so you can start off delivering a certain tidal volume at a certain pressure and then because of compliance changes the patient's alveoli lose the ability to contain the same volume of air, so the patient is losing oxygenation unless you change the settings. My point is that there are a lot of considerations beyond simply delivering a fixed pressure of gas into a patient's lungs and hacking a CPAP may not meet those requirements.
- fiftyacorn 7y agoWould these not be too simple to address the ventilation requirements of the coronavirus? This was the case with the ventilators from a consortium in the UK, where the profile of corona requires more complex ventilation - https://www.theguardian.com/world/2020/apr/13/uk-scraps-plans-to-buy-thousands-of-bluesky-ventilators-coronavirus https://www.theguardian.com/world/2020/apr/13/uk-scraps-plan...
- wormyrocks 7y agoHi, I worked on this project and have a couple comments to address the issues people are raising. - There are established medical protocols to treat COVID-19 patients with BiPAP machines, including the addition of a viral filter to mitigate aerosolizing the virus. People are using these protocols now and we link to them from the site. - There are two separate firmware hacks presented. The first one modifies ~20 bytes and provides UI access to BiPAP code left in the existing binary, which would allow the more common CPAP machines to fulfill the same limited function. The second is a PoC of a 'full ventilator' mode. - The manufacturer's CPAP and BiPAP lines have identical mainboard designs and a near identical array of sensors, which provide realtime data including tidal volume calculations. This project exists as a PoC to show that it would be possible - simple, even - for the manufacturer to convert CPAPs to BiPAPs via an OTA update - or, with significantly more effort, to fully featured ventilators. It is likely that they are reluctant to acknowledge this is possible in fear of destroying the market for the BiPAP machines. - If you are a SleepyHead/OSCAR developer, or have access to an AirCurve S10 and an ST programmer, I would love to talk.
- ENOTTY 7y agoWhat are the differences in the sensors?
- wormyrocks 7y agoCPAP: https://fccid.io/2ACHL-AIR104G/Internal-Photos/Internal-Photos-3173809 https://fccid.io/2ACHL-AIR104G/Internal-Photos/Internal-Phot... BiPAP: https://fccid.io/2ACHL-A10STA3G/Internal-Photos/internal-pictures-2888692 https://fccid.io/2ACHL-A10STA3G/Internal-Photos/internal-pic...
- gmueckl 7y ago> a near identical array of sensors I don't know anything about the devices in question, but from what I know of engineering of medical devices, stating "near identical" makes me listen up. If these devices malfunction, they could hurt people. I expect a device like this to have an extensive array of sensors and a lot of extra hardware for constant self-monitoring. If the two lines of devices don't have exactly identical hardware, the differences need to be checked carefully. The lower tier device may be missing some capabilities because of that. Also, it is not obvious that the main development effort for a medical device often isn't about making a device perform its primary function, but to make it incapable of doing anything else. That includes automatic detection of malfunction and appropriate safe modes (simply turning it off may not be safe!). Of course, all of that needs to be tested and validated very thoroughly. If you ever want to use a hacked device on a patient, you will have to prove that it is up to the same engineering standards. That is no simple task, but it beats hurting or killing people because of bugs. In short, this isn't a job for the regular basement-dwelling hacker, the kind who is happy to have his Roomba drive around with a hacked up firmware. This needs some serious and methodical engineering effort to become practical.
- deleted 7y ago[deleted]
- justicezyx 7y agoTalking about cpap machine, I did some research on it, and found that they are regulated medical device and cannot be purchased without prescription. I suffer chronicle dry nose, moderate empty nose syndrome on the right side (due to surgery done 20 years ago in China), and Deviated Septum (due to injury as kid). One thing often happen to me is during middle of nigh sleep, my left nose duct will be extremely dry, causing me to wake up and switch side (it seems my nasal cycle is completely gone). One idea I wanted to try to fix is to use a cpap + humidifier to pump moisturized air. And I found that I have to get prescription, which I tried with one lab sleep study causing $3000+, and concluded that I do not have sleep apnea, which is one of the symptoms to qualify cpap prescription. Then I started to look for off market cpap machine on Craigslist. No luck, the machines are often old, and beat up after long usages. I did not seriously research if cpap has risks to normal people. But it does not seem harmful, unfortunately it has to be regulated and possibly also become very expensive. Edit: Thanks for the good recommendations. Buying from Chinese site (I often forgot this), nebulizer, etc.
- robterrell 7y agoYou can find CPAPs on eBay, but my understanding is that you'd want a sleep study to validate the correct pressure settings. Are you sure you can't just set up a room humidifier?
- jschwartzi 7y agoOr sleep with a face mask with a Heat and Moisture Exchanger(HME) in it?
- DanBC 7y agoIf you just want moisture and not pressure you might want to look at a nebulizer rather than a cpap.
- neffy 7y agoA case can be made that they are being regulated into being expensive to support the rather dysfunctional American health system's need for high insurance charges. At any rate - have a look over on the Chinese sites, you can pick them up new there for $600 or so. Obviously do your own research, and spend some time on the CPAP jailbreak forums as well - the community there is very supportive.
- VectorLock 7y agoVery great. I was really really curious if this was possible and how much work it would be. As you said a lot of CPAP machines are very close in functionality to BiPAP machines. I could see this being very helpful to people who are having a hard time with CPAP therapy but are having difficultly getting their insurance provider to approve a BiPAP machine which are more expensive (something I've experienced)
- TylerE 7y agoYeah this is something I’m wondering too. I’m on a CPAP, not sure if I could get approved for a bipap or not. I run quite high pressure for straight CPAP (range from 18.8 up the machines max of 20). Some nights I peak around 19.6 but other nights will Max it out. Most bipaps will go up to 25.
- deleted 7y ago[deleted]
- ck2 7y agoif you vent your home cpap machine into an open room and the person using it is infected, congrats you just vaporized the infection onto anyone nearby
- souprock 7y agoCool. Everybody in the home is already infected by the time somebody needs breathing assistance, so this is fine.
- w0mbat 7y agoThe headline switches from singular to plural halfway through. I love this idea though. The manufacturers should get onboard with “emergency BiPAP” mode to make this happen without users having to do an elaborate hack.
- huslage 7y agoAs a CPAP user who needs a new machine, I am now screwed by this. This will, by the time I have a new sleep study, cause all sorts of supply issues.
- VectorLock 7y agoThe pandemic is causing lots of supply issues. I don't think this firmware patch is even going to be a rounding error in the grand scheme of whats going on in the world right now. There are tons of CPAP machines this doesn't cover.
- rswail 7y agoI have a 9 year old machine that still works perfectly well. Why do you need a new machine?
- oxymoran 7y agoIf the the only difference between company X’s CPAP machine and company X’s BiPAP machine is purely software, shouldn’t we just pay and/or force them to unlock the features via update?
- rmrfrmrf 7y agodon't ventilators use intubation? how would this help in that case?
- VectorLock 7y agoVentilators can be used invasively or non-invasively.