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Pulse Oximetry: The Heart of Lifebox’s Work – Honoring Dr. Takuo Aoyagi

June 10, 2021

Kitty Jenkin; Alex Hannenberg, MD; Atul Gawande, MD, MPH

Pulse Oximeter

Adapted from Special Feature on Pulse Oximeters: The invention that changed the paradigm of patient safety around the world. (LiSA (1340-8836) vol28 No3 Page237-308, 2021.03 (in Japanese)

View more articles from this special collection hosted by the APSF on Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi.

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LifeboxDr. Takuo Aoyagi’s invention of the pulse oximeter has saved the lives of millions of people across the globe. After the sadness of his death this year, Lifebox, a non-profit founded by Dr. Atul Gawande with four leading medical organizations to improve surgical outcomes globally, is commemorating his legacy and the evolution that Dr. Aoyagi’s work led to across the healthcare setting.

“It is hard to express the scale of transformation in patient care that resulted from Dr. Takuo Aoyagi’s invention of the pulse oximeter. Effective safety monitoring is an essential part of patient care. Pulse oximeters gave us a way to monitor, with a simple finger probe, the oxygenation of people’s blood. That rapidly made them indispensable and lifesaving across health care – from the operating room and intensive care, to the identification of childhood pneumonia, to the triage of COVID-19 patients. They have become so universal, we can all too easily forget that this transformation in patient care happened in our lifetime – because of Dr. Aoyagi. We hope that Dr. Aoyagi’s family and loved-ones will find solace in the millions of lives that have been – and will continue to be – saved throughout the world because of his genius. Our gratitude to Dr. Aoyagi is boundless. On behalf of Lifebox, thank you,” Dr. Atul Gawande, Lifebox Co-Founder and Chair.

The pulse oximeter displays the level of oxygen in the blood and produces a variable pitch auditory signal with each heartbeat. For surgical teams, this invention allowed them to “see” whether a patient was getting enough oxygen to survive when under anesthesia. Anesthesia providers often refer to their pulse oximeter as their “eyes and ears”.

In high-income countries such as Japan and the United States, pulse oximeters have been the bedrock of anesthetic care for decades. Unfortunately, due to price and adaptability constraints, pulse oximeters are still lacking from many operating rooms in low- and middle-income countries. In 2011, Lifebox estimated that 77,000 operating rooms around the world still lacked this essential piece of medical equipment. Seeking to address this problem, four of the world’s leading medical organizations joined together to globalize Dr. Aoyagi’s invention. The Association of Anaesthetists of Great Britain and Ireland, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, and the World Federation of Societies of Anaesthesiologists led the way with the creation of Lifebox – a non-profit organization that works to make surgery and anesthesia safer. Lifebox’s founding aim was to close the “oximetry gap” by equipping operating rooms with pulse oximeters.

Today, nearly a decade later, Lifebox focuses on three core pillars of safer surgery – improving anesthesia safety, reducing surgical infection rates, and strengthening surgical teamwork. By working alongside local partners, it provides the training and tools needed to save lives through safer surgery. All of this work is rooted in the World Health Organization’s Surgical Safety Checklist.

The Checklist is a simple communication tool that has been proven to reduce complications and deaths from unsafe surgery by up to 40%. When the WHO Surgical Safety Checklist was introduced in 2008, the only piece of equipment included on the Checklist was a pulse oximeter – a testament to the international recognition of the undisputed critical role Dr. Aoyagi’s invention has played in improving surgical safety.

When Lifebox launched, it developed a pulse oximeter specifically designed for use in low-resource settings – with robust construction and rechargeable batteries that stay on even when the power fails. To date, more than 26,000 Lifebox pulse oximeters have been distributed throughout 116 countries for vital patient monitoring. The distribution is accompanied by oximetry and anesthesia safety training, recognizing that for many of the recipients this is their first patient monitoring technology.

“Following a routine cesarean section, I put a pulse oximeter onto the newborn baby as she was wheeled into recovery with the mother. As I prepared for the next patient, I heard the beep of the Lifebox suddenly change pitch; I ran over and saw the alarm going off, as the baby’s saturation started to drop,” explained a nurse anesthesia provider in Sierra Leone who received a Lifebox pulse oximeter. “There was a time in this hospital when this baby would have died because we did not have appropriate oximetry available, but the oximeter is a second set of eyes and ears. Instead I was able to immediately attend to the infant, and support her breathing. A minute more and it would have been a different story – nine months of labor and an operation ending in tragedy.”

Dr. Aoyagi lived to see his invention become one of the most crucial tools in fighting the COVID-19 pandemic. “Silent hypoxia” is a defining feature of COVID-19, with patients slowly starving of oxygen without the usual shortness of breath that would see them seek care. By the time many COVID-19 patients are having trouble breathing, they are already critically ill. The best tool to detect these patients is a pulse oximeter.

With the start of the COVID-19 pandemic in early 2020, Lifebox pivoted its activities to support healthcare workers to provide safe surgical and COVID-19 care and protect themselves. The mainstay of this response has been the distribution of 6,500 Lifebox pulse oximeters to frontline healthcare providers across 43 countries along with guidance on how to use them in COVID-19 care. Lifebox’s COVID-19 response will last as long as the pandemic continues to devastate health systems and lives, but the core mission – to improve the safety of surgery and anesthesia – remains the same. Pulse oximetry remains at the heart of this work.

There is still much work to be done in the global access to pulse oximetry. Lifebox will expand beyond operating room use to ensure monitoring is available for the full perioperative process – from pre- to post-op – in intensive and neonatal intensive care units, and in the transfer of patients to a higher level of care.

Lifebox celebrates the life of Dr. Aoyagi with every pulse oximeter distributed to a healthcare provider. We cannot think of a more lasting legacy to Dr. Aoyagi than the millions of pulse oximeters in use across the world keeping patients safe.


Kitty Jenkin, Head of Communications

Alex Hannenberg, MD, Trustee

Atul Gawande, MD, MPH, Co-Founder and Chairman

Lifebox Foundation


The Lifebox Global Governance Council

Atul Gawande, MD, MPH – Brigham and Women’s Hospital in Boston, Massachusetts, USA

William Berry Bill Berry, MD, MPA, MPH – Ariadne Labs, Brigham and Women’s Hospital in Boston, USA

Miliard Derbew, MD – College of Health Sciences, Addis Ababa University, Ethiopia.

Angela Enright, MB – University of British Columbia, Vancouver Island Health Authority, Canada

Faye Evans, MD – Boston Children’s Hospital and Harvard Medical School, USA

Alexander Hannenberg, MD – Ariadne Labs, Brigham and Women’s Hospital in Boston, USA

Alex Haynes, MD, MPH – Dell Medical School, University of Texas, USA

Deborah Lotterman, MA, Chief Creative Officer, Precisioneffects, Boston, USA

Alan Merry, MB, ChB – Auckland City Hospital, School of Medicine at the University of Auckland, New Zealand

Pauline Philip, DBE – Luton and Dunstable University Hospital Foundation Trust, UK

Nobhojit Roy, MD, MPH – HBNI University, India

Isabeau Walker, BSc, MB, Bchir, former Consultant Paediatric Anaesthetist at Great Ormond Street Hospital, UK

Iain Wilson, MB ChB, former consultant anesthetist at the Royal Devon and Exeter NHS Foundation Trust, UK

Jason Yeung, MPhil, Morgan Stanley, USA

Read more articles from this special collection hosted by the APSF on Pulse Oximetry and the Legacy of Dr. Takuo Aoyagi.