Carl Gunnar Engström

Carl Gunnar David Engström (1 September 1912 – 9 January 1987) was a Swedish physician and innovator. He is the inventor of the first intermittent positive pressure mechanical ventilator that could deliver breaths of controllable volume and frequency and also deliver inhalation anesthetics.[1]

The Engtröm 150 artificial respirator, which delivered air straight into the lungs using an endotracheal tube placed into the windpipe, was invented by Carl-Gunnar Engström.

The Engström150 Respirator (EngströmUniversal Respirator) began series production in 1954. The basic principle of the mechanical ventilator is still the same today, but a technological leap was made with the Siemens-Elema servo fan in the 1970s.

Life

Engström was born on 1 September 1912 in Oskarshamn to Carl Johan Engström and Judith Ringberg. He obtained is degree in medicine in 1941. He worked from 1941 at Stockholm Hospital for Infectious Diseases and started to work in the Swedish Air Force in 1956. He got his PhD in medicine at the Uppsala University in 1963 with a thesis entitled The clinical application of prolonged controlled ventilation: with special reference to a method developed by the author.[2][3][4][5]

Before the invention of Engström, the only available respirator was the iron lung. It is negative pressure ventilator, a mechanical respirator which encloses most of a person's body, and varies the air pressure in the enclosed space, to stimulate breathing.[6][7] It assists breathing when muscle control is lost, or the work of breathing exceeds the person's ability suffering from polio and botulism and certain poisons (for example, barbiturates, tubocurarine).

Rows of iron lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s helping children, and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering.[8][9] This machine kept the patient breathing, with the help of underpressure and overpressure. The whole body, except the head, was placed in a pressure chamber, where it was not possible to regulate how much air the patient received. Engstrom found that the iron lungs did not adequately ventilate patients with severe poliomyelitis.

This problem solved Engström with his respirator, by blowing air into the patient's lungs via a simple tube through the trachea. The respirator had a cylinder to determine the amount of air, and a pump. A tube was inserted into the patient's trachea, a small balloon was inflated as a seal around the tube, and then the respirator pumped air into the lungs. The amount of air and the amount per unit of time was set with a knob.

Engström patented the respirator in 1950.[10] Engstrom's respirators were used for the first time in Blegdams Hospital, Copenhagen, Denmark, during a polio outbreak in 1952.[11][12][13][14] Engström respirators were also tested in the 1953 Swedish polio epidemic.

The Engstrom 150 Respirator (Engstrom Universal Respirator) began series production in 1954. Mivab, the company that first manufactured Engström's respirator, is today a part of the Datex / Ohmeda division of General Electric Health Care.

Positive pressure ventilation systems are now more common than negative pressure systems like the iron lungs. It proved to be lifesaving in other conditions including respiratory insufficiency and soon superseded the iron lung throughout Europe.[15]

References
  1. Gedeon, Andras (31 December 2007). Science and Technology in Medicine: An Illustrated Account Based on Ninety-Nine Landmark Publications from Five Centuries. Springer Science & Business Media. pp. 451–455. ISBN 978-0-387-27875-9.
  2. Engström, C.-G. (1963). "Chapter I: The Basic Principl'es of the Author's Method For Controlled Ventilation". Acta Anaesthesiologica Scandinavica. 7 (s13): 11–15. doi:10.1111/j.1399-6576.1963.tb00221.x. ISSN 1399-6576. S2CID 221393592.
  3. Engström, C.-G. (1963). "Chapter II: Technical Description of the Respirator and Analysis of its Functional Principles". Acta Anaesthesiologica Scandinavica. 7 (s13): 16–30. doi:10.1111/j.1399-6576.1963.tb00222.x. ISSN 1399-6576. S2CID 221393284.
  4. Engström, C.-G. (1963). "Chapter III: Experience of Prolonged Controlled Ventilation in Poliomyelitis". Acta Anaesthesiologica Scandinavica. 7 (s13): 31–33. doi:10.1111/j.1399-6576.1963.tb00223.x. ISSN 1399-6576. S2CID 221393939.
  5. Engström, C.-G. (1963). "Chapter V: A Method for Studies of the Oxygen Uptake In The Presence of Inert Gases". Acta Anaesthesiologica Scandinavica. 7 (s13): 40–42. doi:10.1111/j.1399-6576.1963.tb00225.x. ISSN 1399-6576. S2CID 221394960.
  6. Jackson, Christopher D., MD, Dept. of Internal Medicine, and Muthiah P Muthiah, MD, FCCP, D-ABSM, Assoc. Prof. of Medicine, Div. of Pulmonary / Critical Care / Sleep Medicine, Univ. of Tennessee College of Medicine-Memphis, et.al., "What is the background of the iron lung form of mechanical ventilation?," April 11, 2019, Medscape, retrieved April 12, 2020 (short summary of iron history and technology, with photo)
  7. Grum, Cyril M., MD, and Melvin L. Morganroth, MD, "Initiating Mechanical Ventilation," in Intensive Care Medicine 1988;3:6-20, retrieved April 12, 2020
  8. "NMAH | Polio: The Iron Lung and Other Equipment". National Museum of American History. Smithsonian Institution. Retrieved 28 March 2020.
  9. Resnick, Brian (January 10, 2012). "What America Looked Like: Polio Children Paralyzed in Iron Lungs". The Atlantic.
  10. US US2699163A, Engström, Carl Gunnar, "Respirator", issued 1951-06-25
  11. Engstrom, C.-G. (1954). "Treatment of Severe Cases of Respiratory Paralysis by the Engstrom Universal Respirator". BMJ. 2 (4889): 666–669. doi:10.1136/bmj.2.4889.666. ISSN 0959-8138. PMC 2079443. PMID 13190223.
  12. Louise Reisner-Sénélar (2009). "The Danish anaesthesiologist Björn Ibsen a pioneer of long-term ventilation on the upper airways". Retrieved 2011-07-01.
  13. Wackers, Ger (1994). "Chapter 4". Theaters of truth and competence. Intermittent positive pressure respiration during the 1952 polio-epidemic in Copenhagen. Archived from the original on 2007-12-23. Retrieved 2011-07-01.
  14. West, John B. (2005). "The physiological challenges of the 1952 Copenhagen poliomyelitis epidemic and a renaissance in clinical respiratory physiology". Journal of Applied Physiology. 99 (2): 424–432. doi:10.1152/japplphysiol.00184.2005. ISSN 8750-7587. PMC 1351016. PMID 16020437.
  15. Bjork, V. O.; Engstrom, C. G. (1955). "The treatment of ventilatory insufficiency after pulmonary resection with tracheostomy and prolonged artificial ventilation". The Journal of Thoracic Surgery. 30 (3): 356–367. doi:10.1016/S0096-5588(20)30633-4. ISSN 0096-5588. PMID 13252681.
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