Medtronic ventilators helped save lives during the pandemic, so why is the company shutting down the business?

Medtronic’s top ventilator executive began fielding pleas from world leaders’ representatives five years ago, as pressure from a global pandemic drove a sudden shortage of lifesaving devices that help extremely sick people breathe.

“We need it more than everybody else,” former senior vice president Vafa Jamali recalls hearing from people seeking ventilators for critically sick COVID-19 patients. As the pandemic hit the U.S., Minnesota-run medtech giant Medtronic ramped up production and made blueprints public so other companies could quickly produce their own copies.

Now, Medtronic is shutting down its ventilator business. For Rich Branson, a respiratory therapist and editor-in-chief of research journal Respiratory Care, the company’s recent axing of the historic Puritan Bennett ventilator franchise after decades in production felt like if Ford stopped making trucks.

“People were aghast,” he said.

Medtronic, which controlled nearly a third of the North American intensive care ventilator market in 2022, said recent profit struggles and shifting product demand drove the decision to shut down the Puritan Bennett program. Employees lost jobs.

Now industry experts, doctors, and some of the Fridley, Minnesota-run company’s former executives debate whether the company’s exit leaves the ventilator industry underprepared for future emergencies, such as another respiratory virus pandemic.

Hong-Lin Du, a former Medtronic executive who is now the CEO of a ventilator company, expects panic in the future. Dr. John Hick, who led Minnesota’s Statewide Healthcare Coordination Center during the pandemic, said fewer ventilator makers could lead to less innovation, worse customer service and increased prices.

“Having a diversity of manufacturers and manufacturing lines lends additional capacity to any future pandemic,” said Hick, an emergency physician at HCMC.

Medtronic is confident that ventilator manufacturers “can meet the customer demand.”

“Medtronic determined this business decision was in the best interest of our stakeholders … both near- and long-term, due to the increasing unprofitability and as market preferences shift to lower-acuity ventilators,” the company said in a statement.

What’s certain: Puritan Bennett’s long life as a history-making medical brand is winding down.

Inside an ICU

A ventilator huffed as it pushed air through a tube and into the lungs of Michael Hendrickson in an HCMC intensive care suite overlooking U.S. Bank Stadium in Minneapolis recently. It hissed as it then pulled carbon dioxide out of the 55-year-old patient.

Hendrickson has been on ventilators for more than a year, with this rhythm continuing monotonously.

While many ventilator patients are incapacitated as they receive oxygen through a tube down their throat, others like Hendrickson receive a tracheostomy procedure in their neck, allowing ventilation tubes to bypass the mouth so they can stay awake.

“I don’t really feel the vent,” Hendrickson typed on his phone and showed a reporter, “but I can feel any changes.”

To operate this Puritan Bennett 980 ventilator, a respiratory therapist sets the pace of breaths and the amount of air moving in and out of the chest per breath, HCMC clinical care supervisor Amy Martin said.

An infection tore through Hendrickson’s body, he wrote. He lost his right leg and is blind in his right eye. The device is keeping him alive.

All he wants, he wrote, is to “get off the vent and go home.”

Patients with COVID-19 can develop pneumonia, filling their lungs with inflammation and fluid, said Dr. Jim Miner, who led HCMC’s emergency room during the pandemic.

“The ventilator drives their breathing for them,” Miner said, “so they don’t have to do all that work so they can rest and heal.”

A lifesaver during polio

As another public health emergency — polio — ripped through the United States in the 1940s and 1950s, hospitals looked for an alternative to the massive iron lung machines for ventilation. Inventor V. Ray Bennett thought up a smaller, positive-pressure ventilation device allowing patients to move around, building off an oxygen valve he patented for war planes.

Oxygen company owner Parker B. Francis learned of Bennett’s inventions, and their two companies merged in 1956 to create the one that became Puritan-Bennett Corp.

The company dominated 80% of the United States ventilator market through the 1990s, Branson estimated. Medtronic in 2015 acquired the brand’s parent, Covidien, for $49.9 billion.

Du, the former Medtronic ventilation executive, is now the CEO of ventilator maker Nihon Kohden OrangeMed. He said the United States didn’t stockpile enough ICU ventilators with “sufficient functionalities” before the pandemic. Suppliers can’t deliver raw materials when their own workers are sick, and one missing part can halt production.

It was a recipe for a shortage.

Buzzing cell phone

In 2020, Medtronic’s Jamali said he heard from Irish, Spanish and American leaders’ representatives as Medtronic’s ventilator distribution strategy became a matter of life and death.

Facing a dilemma, Jamali said, “I didn’t want to be political, and I didn’t want price to be an issue.” He shipped them out based on the virus hotspots and caregivers’ ability to operate the devices.

As more patients filled Minnesota ICUs, hospitals started coordinating to balance patients and ventilators, Miner said.

Having already increased ventilator production by 40% since the start of 2020, Medtronic planned to further increase weekly production to 1,000 per week by the end of June 2020. It also made public its design specifications, manufacturing instructions and software source-code files for a 10-year-old ventilator for others to copy.

“The idea was to give innovators, inventors, start-ups, academic institutions — and competitors — a running start on manufacturing lifesaving ventilators to meet global demand,” Medtronic said in a statement last month.

There were more than 220,000 downloads of the specs, Medtronic said. At least two companies pulled it off: Canada’s Baylis Medical and Vingroup, one of the largest companies in Vietnam. A Vingroup research executive called it a “miracle” at the time.

Software engineer and CEO Kyle Wiens of equipment self-repair company iFixit said, “Medtronic really did do a pretty darn good job.”

Initially, ventilator revenues nearly doubled, while overall Medtronic revenue declined by about a quarter for the three months ending April 24, 2020, due to pauses on elective surgeries, the company reported.

Ventilator demand subsided as manufacturing ramped up and doctors started to prioritize less-invasive treatments such as high-flow nasal cannulas delivering oxygen through the nose, said Dr. Alex Teeters, pulmonary and critical care physician at Allina Health.

Now, the U.S. government is trying to whittle the 160,000 ventilators in its pandemic stockpile to about 70,000, Branson said, as the devices are expensive to maintain. And with inventory added during the pandemic, hospitals delayed future purchases.

Canada donated some of Baylis’ devices to Ukraine, and a spokesperson said Vingroup has “realigned its health care priorities to better suit the current landscape.”

Puritan Bennett’s fall

Selling an ICU ventilator that costs more than $50,000 isn’t cheap.

Branson said a medtech company specialist might have to stay in a hotel next door to a hospital for more than a week and remain available 24/7 as it tests various products.

Du said hospitals feel pressured to demand low prices. The quality standard of these devices is high, he said. The industry can be a magnet for expensive recalls and litigation.

The only option for compromise: reduce the profit.

Across the North American ventilator market, Medtronic’s market share decreased from approximately 15% to 10% between 2022 and 2023, said Signify Research analyst Sam Wilson. Revenue growth in Medtronic’s respiratory interventions division was lower than all but one of the company’s seven other business segments by the quarter that ended January 26, 2024.

During a February 2024 call with investors, CEO Geoff Martha announced that Medtronic would “exit” the ventilator business, thanking the employees “who played an incredible role during the pandemic.” Months later, Medtronic issued a recall notice for tens of thousands of ventilators that may build up volatile organic compounds that could pose a risk to health if the devices are more than 14 years old. The ventilators generally have a 10-year service life.

The market exit led to job cuts. Medtronic said it doesn’t disclose layoff figures, but it redeployed employees to roles in other parts of the company when possible, and if this wasn’t feasible, it “provided comprehensive transitional support.”

“The decision to wind down the ventilator business was not made lightly, and there was a great deal of consideration for our employees and how they were affected,” Medtronic said of the layoffs.

Medtronic isn’t the only company leaving the ventilator industry. Dutch conglomerate Philips stopped selling ventilators in the United States after issuing a massive recall linked to patient deaths. GE HealthCare has also left the ICU ventilator market, Wilson said. Five medtech companies continue to operate in the U.S. ICU market, he said.

Jason Case, the vice president of research and development for Medtronic’s acute care and monitoring division, said ventilators are “a critical part of intensive care. It’s not the only part, but it’s a critical part.”

In the absence of ventilators, the Medtronic division is doubling down on remote patient monitoring technologies used in the intensive care unit, like those that helped convert the Jacob Javits Convention Center in New York City to an overflow hospital with 400 beds over Easter weekend in 2020. One clinician could watch over 40 patients at a time, he said.

“We want to automate, automate, automate, connect and automate,” Case said.

The future

In a beige room across the hall from Hendrickson’s ICU suite in downtown Minneapolis, HCMC stores about a dozen Puritan Bennett ventilators. Allina Health’s Dr. Teeters said, “They’re pretty much industry standard.”

Eventually, they won’t be.

Du said this means “the nation may be less prepared.”

Medtronic said it will continue servicing its ventilators on the market, but HCMC’s Dr. Hick called Medtronic’s exit “a big concern.” He worries that device maintenance may become harder and prices for the lifesaving devices could become volatile.

“Market constriction, from our standpoint, is never a good thing,” Hick said.

Wilson, the market analyst, said the company left a “large hole,” but he thinks other vendors can fill it.

Medtronic’s remote monitoring technology for ventilators works with other vendors’ devices, and this will continue, Case said.

Despite the business changes, Case said, “being connected to ventilators and making sure that people get the best care they can is still a part of what we’re doing and our mission here.”