‘CanaryBox’ Device Works to Refocus Attention During Stressful Situations in Operating Rooms

An innovative Lincoln-based company enhances operating room focus and patient safety through the 'CanaryBox' device, which reduces surgeon's music volume in response to changing patient conditions.

Canary Sound Design Logo and Tagline

Omaha, Nebraska – An innovative idea sparked by an emergency situation in an operating room has led to a Lincoln-based company and its CanaryBox, a device that reduces or silences music commonly played in an OR during surgery based on negative changes in a patient’s condition.

The company, Canary Sound Design LLC, was co-founded in 2018 by Alistair MacDonald, M.D., an anesthesiologist in Missoula, Mont., Eric Crimmins, M.D., an anesthesiologist in Lincoln, and his wife, Annie Crimmins, an experienced critical care nurse.

Dr. Crimmins earned his medical degree from the University of Nebraska Medical Center and has been practicing anesthesiology for 20 years, specializing in cardiothoracic and vascular anesthesia for the last 15 years.

Dr. MacDonald, the company’s CEO, and Dr. Crimmins, the Chief Clinical Officer, completed their residencies at the University of Washington and met in Seattle, where Annie Crimmins worked as a critical care nurse at Harborview Medical Center. She is the Chief Operating Officer for Canary Sound Design. The Crimmins live and work in Lincoln.

Annie Crimmins says it is estimated that music is played during surgery in 90 percent of all operating rooms. She says studies indicate music reduces surgeon stress, improves focus and can help a patient relax at the beginning of the operation. However, an OR can become “noise polluted” by beeping monitors, clinical alarms, clanging medical equipment and instruments, and muffled conversations. That mix of loud sounds can also lead to “alarm fatigue,” when alarms can be inadvertently ignored simply because of their frequency and the background noise.

In 2015, when a patient’s oxygen saturation dropped to an alarming level as he tried to awaken her after laparoscopic surgery, Dr. MacDonald found himself shouting to others in the OR who didn’t recognize the situation to “turn off the music.” The patient recovered, but Dr. MacDonald subsequently learned from colleagues of other instances where poor outcomes were attributed to intraoperative noise. “I wondered, ‘Why can’t the audio system be aware of the patient’s vitals . . . and turn itself off?’” he recalls. “There is intelligence built into $20,000 cars that is completely absent in a $2 million operating room.”

In an effort to improve attention in the OR particularly during situations where the patient’s condition changes and alarms are sounded, Dr. MacDonald took on the issue of the “jumble of disturbing noise” and began the work that would eventually result in the CanaryBox.

Dr. Crimmins and Annie Crimmins came aboard as co-founders to infuse their enthusiasm for the project, provide ideas and help seek capital.

The trio has worked with Communications System Solutions in Lincoln on the design, software and manufacture of the prototype device. They obtained a $50,000 grant through the Nebraska Department of Economic Development for the prototype, as well as a $25,000 matching grant from the Lincoln Partnership for Economic Development.

They have also sought advice from the Nebraska Business Development Center (NBDC) and its Innovation and Technology Program, directed by Josh Nichol-Caddy.

The Canary Box controller interfaces with most standard anesthesia monitors and responds to preset or customized settings regarding changes in a patient’s heart rate, oxygen saturation and blood pressure.

Most recently, Annie Crimmins says, the company has entered into an agreement with Karl Storz Endoscopy-America, Inc., to further sales and integration of the CanaryBox into ORs equipped with Storz monitors, under the stipulation that its manufacture remain in Lincoln.

Dr. Crimmins says the goal is to increase the focus of the OR team and improve patient outcomes. “It is primarily a patient safety issue,” he says. “We want to balance the beneficial effects associated with music with alarm recognition and vigilance.”

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The Nebraska Business Development Center (NBDC) helps Nebraska businesses start, grow and develop, by strengthening Nebraska businesses for a healthy economy and prosperous communities. NBDC is a University of Nebraska at Omaha center that provides confidential consulting business development services across Nebraska to entrepreneurs and business owners for the life cycle of their business. NBDC partners with the University of Nebraska-Lincoln, University of Nebraska at Kearney, University of Nebraska Medical Center, Wayne State College, and Chadron State College to deliver its services statewide. The U.S. Small Business Administration, the U.S. Department of Commerce, and other federal, state, and private organizations support NBDC. The Nebraska APEX Accelerator is funded in part through a cooperative agreement with the Department of Defense. Visit nbdc.unomaha.edu for more information.

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