Vacuum bell (medicine)

The vacuum bell is a medical device used in the treatment of pectus excavatum (PE), one of the most common chest wall defects.

Initial evidence suggests the device may be useful as a non-surgical treatment for mild cases of PE, but there has been a lack of evidence for a long-term effect.

Overview
The vacuum bell was invented by German engineer Eckart Klobe in order to treat the cosmetic problems associated with the condition, as symptomatic problems caused by pectus excavatum are usually more severe and may require surgery. Currently, there are two leading versions of the vacuum bell (Costa and Klobe) are available, in a range of different sizes in order to allow for the treatment of a range of patients. The device works by establishing a vacuum, of up to 15% below atmospheric pressure, above the patients chest in order to draw the sternum out into a more normal position. Whilst the immediate effects of the device are only temporary as the sternum will revert to its original position after usage, the continued usage of the device is believed to have a permanent impact on the position of the breastbone. Many patients have reported an improved appearance to the sternum after 2–3 years of regular usage.

The rubber bell is placed onto the chest wall so that a seal is created, and a hand pump connected to the bell by an air tube is used to reduce pressure inside the bell to up to 15% below atmospheric pressure. The drop in pressure results in the sternum being lifted upwards and a temporary resolution of the deformity.

Reception
A single study published in the European Journal of Cardiac-Thoracic Surgery in 2006 concluded that device appeared to be "an alternative therapeutic option in selected patients with PE" but noted that long-term results had yet to be assessed and further studies were needed.

A 2010 review of the device concluded that it might be useful in allowing some people with PE, particularly those with a mild condition, to avoid surgery, and that it "[seemed] to be a valuable adjunct therapy in the treatment of PE." Computed tomographic scans showed that the device lifted the sternum and ribs immediately.

A 2011 review also reported that preliminary trials of the device had indicated it might be useful for treatment of less severe cases of PE, but that "long-term results are still lacking".

In 2012 the vacuum bell device was used for two non-surgical procedures at the Children's Hospital of the King's Daughters' research center.

Contraindications
Use of the bell is not advised if any of the following conditions are present in a patient:
 * Angiopathy
 * Aneurysm
 * Blood coagulation disorders (e.g. Hemophilia).
 * Disorders affecting bone firmness (e.g. Osteogenesis Imperfecta, Osteoporosis).

Side effects
Possible side effects from using the device include:
 * Pneumothorax - collapsed lung
 * Hematoma
 * Backache
 * Drops of blood appearing on the skin
 * Local edema
 * Excoriation
 * fluid developed under the skin
 * suffocation