Everest research resurrected

A partnership between Smiths Medical and University College London has resulted in the development of a breakthrough clinical device.

A partnership between Smiths Medical and University College London (UCL) has resulted in the development of a breakthrough clinical device that could transform the lives of patients with Chronic Obstructive Pulmonary Disease (COPD).

COPD, a disease of the lungs in which the airways become narrowed leading to a limitation of the flow of air to and from the lungs causing shortness of breath, will be the third leading cause of death worldwide by 2030, according to the World Health Organisation (WHO).

The new technology is based on a closed circuit oxygen device invented more than 50 years ago by the British rocket scientist Tom Bourdillon, who hoped it would help take him to the top of the world.

Three days before Edmund Hillary and Tenzing Norgay made the first ascent of Mount Everest in 1953, Bourdillon nearly got there first with the help of his ground-breaking invention.

When he and his climbing partner Charles Evans, a British brain surgeon, set out on the first ever summit attempt they were breathing pure oxygen from the device. It helped them climb higher than any man had ever been before and at speeds that have rarely been matched since.

The two men were just 90m from the summit when Evans’ device malfunctioned, dashing their hopes of becoming the most celebrated mountaineers in the world. Three days later, Hillary and Norgay claimed that honour using open circuit oxygen devices.

Bourdillon believed that closed circuit oxygen was more efficient and effective than open circuit because a closed circuit efficiently recycles exhaled oxygen, which would be lost to the atmosphere in an open circuit.

His research was forgotten for 50 years but now Smiths Medical and UCL have developed Bourdillon’s idea into a new medical device that could help patients with COPD.

Dr Jeremy Russell, head of research and development at Smiths Medical International, said: ‘We are hoping that this technology will transform the lives of people living with COPD by allowing them to breathe more easily, exercise and ultimately reduce their dependence on oxygen. It is incredible to think that this breakthrough device is based on a British invention designed to help the first mountaineers reach the top of the world.’

Bourdillon’s research was rediscovered by Jeremy Windsor and Roger McMorrow, mountaineering scientists at the UCL Centre for Altitude, Space and Extreme Environment Medicine (CASE), who had the idea to redevelop it into a modern breathing circuit for climbers.
Dr McMorrow said: ‘Bourdillon recognised that the problem on Everest was low levels of oxygen and if you solved the problem of delivering oxygen you would effectively reduce the height of the mountain to sea level. No one knows exactly why his device failed but when I tested my prototype on Cho Oyu in the Himalayas in 2005 it also failed.

‘In my case, the soda lime CO2 absorber malfunctioned and it is possible Bourdillon had the same problem, although another theory is that it was a frozen valve. A recently invented CO2 absorber called ExtendAir solved the problem on my circuit.’

Dr McMorrow, while a Smiths Medical Research Fellow at UCL, showed his mountaineering prototype to Russell at Smiths Medical, which has a long-standing partnership with UCL that includes collaboration on research in the field of respiratory medicine.

The two scientists quickly realised that the prototype for mountaineers had the potential to evolve into a device for COPD patients as well as for other patients weaning from oxygen in hospital and those on home oxygen.

Last year the device was successfully tested on Mount Everest at the Smiths Medical High Altitude Laboratory at Namche Bazaar, Nepal, at 3,400m (11,154 ft) as part of the Caudwell Xtreme Everest Study (CXE), a medical research project conducted by CASE. Smiths Medical is now optimising and miniaturising the prototype for patients.

Exercise is important for COPD patients but existing oxygen systems mean it is often not possible. The size of current open circuit systems means that patients are often confined to their hospital beds or treated at home with large cylinders that severely restrict their mobility.

Portable open circuit systems are not able to deliver high enough volumes of oxygen for long enough to permit exercise. In an open circuit system the faster a person breathes, the more they dilute the oxygen with ordinary air. This means that if a patient dependent on oxygen starts to exercise, their oxygen levels actually drop as their breathing grows faster.

Russell added: ‘The new system is portable and should deliver a very high concentration of oxygen for a sustained period of time. It should help keep oxygen levels constant no matter how fast or slow a patient is breathing.’

Previously, portable closed circuits have been used by Special Forces frogmen (because there are no bubbles), mine rescue workers, firefighters and in bioterrorism suits.

Prof Monty Mythen, Smiths Medical professor of anaesthesia at UCL and director of research and development at UCL Hospitals, said: ‘This project is a fantastic example of the success that comes from scientists in industry working closely with clinicians and university academics for patient benefit.’