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Q&A with Respair's Founders

Innovation Works

Jan 27, 2023

Respair founders sit down with Innovation Works to discuss the history and progress of Respair Inc.

Q&A With Respair Inc Founders

Meet the team that created — RelianceET, an endotracheal tube that creates a superior seal in patient airways to prevent harmful secretions from entering the lungs.

Endotracheal tubes have used an inflatable balloon element for more than 40 years. Respair’s device replaces that inflatable element with ultra-soft atraumatic baffles that act like a stopper, comprehensively sealing the airway without applying harmful force.

Respair Inc. was founded in late 2021 after successfully developing and pitching their endotracheal tube solution, RelianceET (previously NextGenET), at the University of Pittsburgh. After more than 70 customer interviews and support from Pitt’s Swanson School of Engineering, their team won several awards within the University. With that initial funding, they refined their design and business plan and ultimately took the leap beyond the University to continue the journey as Respair.

We sit down with founders Ross Beresford (Chief Executive Officer), Dr. Carl Snyderman (Chief Technology Officer), and Dr. Garrett Coyan (Chief Medical Officer) to learn more.

Could you provide background on your education and how your research led to this idea?

Like most great products and ideas, we started by pointing in the wrong direction. Dr. Snyderman, a head and neck surgeon with 40 years of clinical experience, was initially focused on the detection and prevention of movement of endotracheal tubes, an important safety issue for patients with breathing tubes.

Through contacts at the engineering school, Dr. Snyderman was connected to Dr. Coyan, a cardiothoracic surgeon with similar interests in airway problems. He quickly learned that while migration is a problem, it is not THE problem.

The biggest problem in terms of negative outcomes for patients and cost for hospitals is acquiring a secondary infection while on a ventilator. These secondary infections, like ventilator-associated pneumonia, have an average mortality rate of around 35% and can cost up to $40K per episode.

The root cause of these infections is caused by deficiencies in current endotracheal tubes that allow harmful secretions to enter the lungs in ventilated patients. Through those early conversations, Dr. Snyderman and Dr. Coyan joined forces, each bringing a different clinical perspective from overlapping disciplines. Together, they developed the concept of RelianceET to challenge the current standard of care.

Ross, with a master’s in bioengineering for medical products, joined the team in 2021 and leveraged his experience inside the Pitt ecosystem to accelerate the idea toward commercialization and the team to new-company formation.

Dr. Carl Snyderman — “As Quality and Safety officer for my department and through my service on Airway committees at UPMC, I was well aware of airway problems related to current technology. I became interested in medical device development as part of my executive MBA at the University of Pittsburgh Katz School of Business. After pitching ideas for medical devices to bioengineering student classes for multiple years, I was fortunate to connect with Dr Coyan and Mr. Beresford.”

How did you explore creating your product?

We benefitted from being in the University/UPMC ecosystems early on, which allowed us to access unique funding opportunities and resources to create our product concept and solicit feedback. We started with interviewing stakeholders (physicians, nurses, respiratory therapists, and administrators) that use or purchase endotracheal tubes to build our journey map and needs. From there, we ideated, prototyped, and iterated with the support of Pitt’s Clinical and Translational Science Institute (CTSI), Center for Medical Innovation (CMI), and Idea Lab, led by Buddy Clark and Brandon Barber. All these resources allowed our team to quickly create prototypes and iterative proof of concept tests to evaluate key aspects of our designs.

Ross Beresford — “The University of Pittsburgh offers numerous resources to faculty, students, and staff interested in developing new technologies. We were able to get the most out of those resources, and they helped us at every step of the process, enabling us to grow into our company.”

Dr. Carl Snyderman — “I have benefitted greatly from the abundant resources for medical entrepreneurship at the University of Pittsburgh. This includes team coursework on medical device development, funding opportunities, and assistance with intellectual property development.”

Why are you the best team to champion this product?

Our team is comprised of top physicians, Dr. Coyan and Dr. Snyderman, with decades of experience managing airway-related issues directly, making them subject matter experts. On top of clinical expertise, our physician founders also bring business and deep entrepreneurial networks to our team that helps us get an early foot in the door with investors and key strategic partners.

Ross, as our CEO, has keen experience preparing early-stage technologies and developing University based projects. He also has specific knowledge in creating and managing medical devices. The Respair team collectively brings together high-quality clinical subject matter expertise, medical device knowledge, and professional networks. Additionally, connectivity with Innovation Works and Allegheny Health Network, through AlphaLab Health, creates an opportunity to fill knowledge gaps and find enthusiastic talent to help us grow our company and deliver high-quality products to patients.

Ross Beresford— “We’ve been fortunate to have multi-faceted experts on our team that have helped us excel at an early stage. However, we know that we don’t have all the answers, but now, through AlphaLab Health, we’ve got new mentors, founders, and experts to ask in order to ensure we add the best people to the right roles at the right times to enable our long-term success.”

Dr. Carl Snyderman — “Our team has great diversity of experience and complementary knowledge, skills, and networks that synergize to create the perfect team. Personally, this is a great learning experience and growth opportunity at the peak of my career. I am also blessed to have partners with great character and camaraderie.”

Dr. Garrett Coyan — “Not many physicians get the chance to improve the care of patients globally outside of their local practice. For Dr. Snyderman and myself, we have adopted the attitude that creating new devices and therapies, such as the RelianceET, is the most effective way to help the largest number of patients with critical respiratory conditions. It is based on this enthusiasm that the entire team is aggressively pursuing the commercialization of this life-saving technology.”

(Left to right) Dr. Garrett Coyan, Dr. Carl Snyderman, and Ross Beresford are awarded first place for their winning pitch at the University’s Pittsburgh Innovation Challenge competition (PInCh) for $115,000.

What were some aspects of the processes that surprised you?

I think there were two big things that surprised. The first is simply the magnitude of the problem related to ventilator-acquired infections. These infections impact hundreds of thousands of people in the United States every year and have estimated mortality rates of around 35%. This situation has worsened with COVID. Early estimates show secondary infections with a COVID diagnosis can increase mortality an additional 10%. Simply put, these infections have gone under the radar as a massive healthcare problem.

The second aspect is the fact that there have been very few innovations or design improvements made to endotracheal tubes. Yes, there have been small changes to the materials and shape of the cuff, but no meaningful innovation, despite apparent and well-documented shortcomings of current designs, for the past 40 years.

Ross Beresford— “On top of the functional aspects of the problem, we’ve been blown away at the engagement and willingness to support early-stage founders in the Pittsburgh life-science ecosystem. From University resources to LifeX to Innovation Works and more, there are numerous interconnected channels to get started on your journey and connect with great people.”

Dr. Carl Snyderman — “I am impressed by the commitment it takes to get a product to market. It truly takes a team with diverse knowledge and skills to succeed.”

Dr. Garrett Coyan — “Learning how to engage in product development, regulatory strategy, intellectual property protection, and business management are not skills traditionally taught to physicians. As this is personally my second medical device start-up, the unique opportunities to pursue in these areas continues to fascinate me, and I enjoy every minute I spend working on developing these core capabilities at Respair.”

How did you make sure your product was a reflection of your target audience’s needs?

We made and continue to make sure to ask them! Taking a human-centered design approach to our ideation and prototyping allowed us to bring more iterative feedback into medical devices, a historically difficult and slow-moving environment.

We’ve conducted various interviews, usability tests, engineering design reviews, and economic assessments with real people that are a lot smarter than us! The answers are often outside the room, and we’ve been able to leverage our networks at Pitt, UPMC, AHN, and beyond to take the problem head-on and challenge our assumptions at every step in the process. This helps us build confidence in our product, ensuring that we’re creating an effective device for patients and clinicians, as well as a solution that makes economic sense for hospitals to buy.

Ross Beresford — “Medical devices bring a unique challenge of balancing different stakeholders. The users of the devices are often very different from the purchasers, who are different from the recipients of care. Everyone in this process has different needs that have to be considered. We’ve been fortunate to build great relationships through this process with people that won’t shy away from providing direct and honest feedback. Having consistent feedback has made our development process stronger at every step.”

Dr. Carl Snyderman — “We are fortunate to work in an environment where we have ready access to all stakeholder groups. We have explored this problem from all viewpoints and feel that we have a solution that addresses everyone’s needs. We benefit from an extensive network of clinical, business, and industry contacts nationally and internationally.”

What has been some of the customer feedback?

While our development remains ongoing, the feedback has been very positive. Clinicians and administrators alike have been supportive of the design based on the long-term seal performance, ability to flex dynamically with the airway, and ability to clear the airway upon removal, unlike any other endotracheal tube. Equipment managers have liked the simplicity of the design and how that potentially enables scalable manufacturing, packaging, and delivery.

Our design is visually quite different from current endotracheal tubes, so there was a question that our product in a trained hand may simply not be viewed as intuitive or usable. What we’ve discovered has been quite the opposite. In a simple head-to-head usability assessment on airway mannequins, our device was intuitive to use and actually preferred by more than half of the physician participants, with the remaining physicians having a neutral preference. At this early stage, the level of user engagement and positive feedback we’ve received has been vital to confirming or correcting our development process.

Ross Beresford— “We’re trying to disrupt the use of a product that hasn’t been changed in 40 years in a very complex healthcare space. It is incredibly beneficial to our process to have some early validation that our design is viewed as intuitive and comfortable for physicians is hugely beneficial to our process.”

Dr. Carl Snyderman— “The airway is managed by multiple disciplines with different issues and priorities. We are encouraged that each stakeholder group sees value in our product at all levels of experience.”

Dr. Garrett Coyan — “Clinicians are desperate for innovation in this space; ventilator-associated complications are a scourge to our critically ill ICU patients, and any therapeutic with even modest potential to help is welcome. We have seen great initial feedback on our product as it does not require significant re-training and in fact makes airway management more straightforward for busy ICU clinicians; this is an encouraging finding for our hard-working development team.”

How does AlphaLab Health help you reach your goals?

AlphaLab Health, in its connectivity with AHN and IW, creates an incredible, one-of-a-kind ecosystem of knowledge and resources. By creating a physical and digital collaborative space with businesspeople, clinicians, and founders, we are able to adopt a holistic view of our product and business development. As an early-stage company, getting advice on do’s and don’ts is invaluable to improving our efficiency. Specifically for our work, the connectivity to clinical partners at AHN provides a unique opportunity to continue collecting feedback from health systems and build clinical partnerships with world-class experts in the field.

Additionally, the physical space provided by AlphaLab Health creates a foundation for our office work and laboratory testing. This resource is truly invaluable for our type of product, as acquiring lab space is an expensive and often painful process. Our technology requires a lab space to conduct testing that enables us to reach safety milestones and raise additional funds. Now we have the resources we need, all in one place, to get the job done and reach that next level.

Ross Beresford — “AlphaLab Health is a catalyzing event for our company. It allows our team to accelerate our product development and business operations rapidly in a thoughtful and sustainable way.”

Dr. Carl Snyderman— “AlphaLab Health has provided us with an expanded network with fresh viewpoints that confirm our initial approach and help us refine our business model. The ability to have discussions and learn from others at different stages of development is invaluable.”

What is next?

A little bit of everything, to be honest! Through AlphaLab Health, we’ll be able to grow our team to focus on strategic product development, business operations, regulatory, and manufacturing objectives — all of which sets our company up to be competitive for follow-on investment. Importantly, we’re aiming to complete our benchtop safety tests and obtain feedback from FDA to solidify our regulatory testing strategy, which is a critical inflection point for our product. This would be almost impossible to achieve so quickly without AlphaLab Health.

Ross Beresford— “We have so many activities on the go, but we couldn’t be more excited about what the future holds for our team.”

Dr. Carl Snyderman— “We have a lot of ‘irons in the fire’ right now. AlphaLab Health is providing the foundation to manage them all.”

What is the most important thing for readers to know about what Respair does and how that’s beneficial to users?

Although endotracheal tubes and ventilators save many lives, they are not a perfect solution. The frequency and normalization of patients developing a secondary infection is simply too big a problem to ignore.

The COVID pandemic has increased awareness of the serious nature of respiratory illness and highlighted the clear need for improvement in lifesaving airway devices. Respair is focused on improving outcomes and reducing complications to ensure vulnerable patients have the greatest chance of survival.

We provide a solution that is easily adopted by all involved in the care of these patients. In initial testing, RelianceET creates a 98% better seal and exerts less force on the trachea than today’s standard inflatable ET tubes. In ICUs and emergency departments, our device has the potential to replace every endotracheal tube used and provide additional life-saving protection for every patient requiring ventilation.

Ross Beresford — “Going on a ventilator is a last resort for patients in the most critical state. Our mission is to improve the tools clinicians have available to reduce preventable infections in order to give patients the best chance of survival.”

Dr. Carl Snyderman — “The most elegant solutions are often the simplest. RelianceET is a ‘gamechanger’ that is going to make people wonder why this didn’t happen sooner.”

How can consumers follow you?

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Also, be sure to follow AlphaLab Health and Innovation works for additional updates ☺

Outside of work, what do you like to do in your free time?

Ross Beresford— “As a Scottish native, I’m a big soccer fan and watch most weekends, often disappointed, but not this year (go Arsenal!). Outside of work, I also play the guitar and enjoy keeping up with friends from afar through video games. I’ll also patiently stand in long lines for pigeon Bagel and pay cash for the best noodles in town from NoodleHead.”

Dr. Carl Snyderman— “Tennis and trekking are my two favorite outdoor activities. I enjoy Scrabble with my wife (especially during COVID), jigsaw puzzles, and writing bad poetry (mostly limericks). I have a big stack of books I hope to read.”

Dr. Garrett Coyan— “I enjoy spending time with my young children with what little free time I can muster. My wife and I are avid sailors, enjoy golfing, and compete for who can row the most meters weekly on our rowing machine.”

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