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The Use of Portable Oxygen Concentrators in Low-Resource Settings: A Systematic Review

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  02 March 2022

Craig D. Nowadly Open the ORCID record for Craig D. Nowadly [Opens in a new window] ,
Daniel J. Portillo Open the ORCID record for Daniel J. Portillo [Opens in a new window] ,
Maxwell L. Davis ,
R. Lyle Hood Open the ORCID record for R. Lyle Hood [Opens in a new window]  and
Robert A. De Lorenzo Open the ORCID record for Robert A. De Lorenzo [Opens in a new window]
Craig D. Nowadly*
Affiliation:
Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TexasUSA
Daniel J. Portillo
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TexasUSA
Maxwell L. Davis
Affiliation:
Department of Respiratory Therapy, Keesler Air Force Base, Biloxi, Mississippi, USA
R. Lyle Hood
Affiliation:
Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TexasUSA Department of Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
Robert A. De Lorenzo
Affiliation:
Department of Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TexasUSA
*
Correspondence: Craig D. Nowadly, MD Department of Emergency Medicine 3551 Roger Brooke Dr Fort Sam Houston, Texas 78234 USA E-mail: craig.d.nowadly.mil@mail.mil
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Abstract

Introduction:

Portable oxygen concentrators (POCs) are medical devices that use physical means to separate oxygen from the atmosphere to produce concentrated, medical-grade gas. Providing oxygen to low-resources environments, such as austere locations, military combat zones, rural Emergency Medical Services (EMS), and during disasters, becomes expensive and logistically intensive. Recent advances in separation technology have promoted the development of POC systems ruggedized for austere use. This review provides a comprehensive summary of the available data regarding POCs in these challenge environments.

Methods:

PubMed, Google Scholar, and the Defense Technical Information Center were searched from inception to November 2021. Articles addressing the use of POCs in low-resource settings were selected. Three authors were independently involved in the search, review, and synthesis of the articles. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.

Results:

The initial search identified 349 articles, of which 40 articles were included in the review. A total of 724 study subjects were associated with the included articles. There were no Level I systematic reviews or randomized controlled trials.

Discussion:

Generally, POCs are a low-cost, light-weight tool that may fill gaps in austere, military, veterinary, EMS, and disaster medicine. They are cost-effective in low-resource areas, such as rural and high-altitude hospitals in developing nations, despite relatively high capital costs associated with initial equipment purchase. Implementation of POC in low-resource locations is limited primarily on access to electricity but can otherwise operate for thousands of hours without maintenance. They provide a unique advantage in combat operations as there is no risk of explosive if oxygen tanks are struck by high-velocity projectiles. Despite their deployment throughout the battlespace, there were no manuscripts identified during the review involving the efficacy of POCs for combat casualties or clinical outcomes in combat. Veterinary medicine and animal studies have provided the most robust data on the physiological effectiveness of POCs. The success of POCs during the coronavirus disease 2019 (COVID-19) pandemic highlights the potential for POCs during future mass-casualty events. There is emerging technology available that combines a larger oxygen concentrator with a compressor system capable of refilling small oxygen cylinders, which could transform the delivery of oxygen in austere environments if ruggedized and miniaturized. Future clinical research is needed to quantify the clinical efficacy of POCs in low-resource settings.

Keywords

austereEmergency Medical Servicesmechanical ventilationmilitary medicineoxygen therapyportable oxygen concentrator
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 2 , April 2022 , pp. 247 - 254
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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