At the end of an afternoon surgery in 2014, anaesthesiologist Dr. Alistair MacDonald took the oxygen mask off a patient and noticed her skin was turning blue. Other members of the surgical team were getting ready for the next procedure, cleaning the medical tools and jamming out to music playing in the operating room, but the patient's oxygen saturation was dropping dramatically.
MacDonald doesn’t recall what song was playing, but he remembers it being extremely loud – so loud that he had to shout over it to get everyone's attention. A nurse quickly stabilised the patient, and the music blared on.
At the moment a nurse silenced the music, a thought occurred to MacDonald: why didn’t the music system know that the patient’s oxygen levels were degrading and turn itself off?
“Why can't the volume of the music be coupled to the patient's vital signs?,” he says. “I thought there had to be a way to integrate those two pieces of equipment, and have volume control automatically. My car can integrate my seatbelt with the music system, with incoming calls, and with impending collisions. So there's intelligence built into a $20,000 car system that is completely absent in a $2 million operating room.”
By 2018, that realisation – and a tragic story about a Michigan teenage patient dying after suffering an anoxic brain injury due to a missed ventilator alarm that was muted by music – had led MacDonald into creating a prototype of the CanaryBox, a smart music system the size of an iPad that decreases or shuts off music when a patient’s vital signs are critical. The CanaryBox can also be customised by its users to link to a patient’s blood pressure, heart rate, and pulse oximetry. “I didn’t want to piss off my fellow surgeons and medical professionals by having the CanaryBox turn off the music for everything,” MacDonald says.
A 2017 study found that average noise levels in American operating rooms can reach up to 130 decibels, much higher than the Environmental Protection Agency’s recommended 45 decibels. “There is the humming of the machine that blows warm air into a blanket so the patient doesn’t get too cold. There is the sound of drills and hammers echoing off the wall. People may be talking to one another about the case,” says Dr. Daniel Orlovich, a clinical instructor for the department of anaesthesiology, perioperative & pain medicine at Stanford University. On top of that, music is usually played during surgeries. That is not a bad thing: there are studies showing that music in the operating room is positive for both the medics and the patient. “It would be absolute torture to operate without music,” MacDonald says.
Yet, any medical professional who has ever stepped in an operating theatre will have their own chaotic anecdotes about loud music. Dr. Joseph Schlesinger, an associate professor in the Department of Anaesthesiology at Vanderbilt University, remembers one case during an operation for removing cancerous tumours from a pancreas. He recalls “thundering country music” – specifically Toby Keith’s “I Wanna Talk About Me” – playing as the head surgeon “nicked the inferior vena cava,” the big blood vessel carrying blood from the lower body to the heart. “If you make a hole in that, it is obviously going to bleed out,” Schlesinger says. The patient’s blood pressure plummeted and Schlesinger, who was teaching a resident about waveforms, luckily noticed while looking at the heart monitor.
“So I'm there pushing fluids, pushing epinephrine trying to keep the patient alive. And I say to the circulating nurse, ‘Turn down the music and get the crash cart’.” The surgeon tried to fix the hole and yelled back and forth with Schlesinger over the 2001 country hit. Had Schlesinger not looked at the heart monitor, that patient could have died.
Currently, Schlesinger is using the CanaryBox both in his operating rooms and in his research. With his team, he is studying the effects of decreasing music volume to alert anaesthesia providers to “alarm events”.
It is not as though operating rooms suffer from a dearth of medical alarms in charge of flagging emergencies – the problem, in fact, is that there are too many of them. During a typical surgery, alarms from patient monitors, infusion pumps, mechanical ventilators, defibrillators, and so on are constantly chiming. But research has shown that in most hospital settings, 85 per cent of alarms have no clinical significance.
“So we hear an alarm and we know it's probably false,” Schlesinger says. “We know that in seven to ten seconds, if it's false, it self corrects. But it's not like we sit there with a stopwatch, so we have this almost lackadaisical attitude to alarms because our normal is this constant cacophonous sound.”
But CanaryBox can be set to lower the music with a certain delay – a feature that, Schlesinger explains, makes him much more aware of a potential critical situation. “So if I set a ten-second delay, when the volume changes, the chance of it being a real alarm is much, much, much higher,” he says.
CanaryBox is about to release its second version, an update from the Raspberry-Pi-based single board computer units that are currently being used in hospitals in Oregon, Nebraska, Minnesota and more. MacDonald has also teamed up with Karl Storz, the world’s leading endoscopy manufacturer, to release the CanaryBox as an advanced intelligent addition to the operating room.
“Right now we’re depending on human vigilance and there's a potential for human error and human distraction,” MacDonald says. “We need a piece of technology to make it easier on everyone.”
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This article was originally published by WIRED UK
