Building Qatar severe respiratory failure ECMO program

Joint Authors

Hasan, Ibrahim Muhammad Fawzi
al-Shaykh, Loua

Source

Qatar Medical Journal

Publisher

Hamad Medical Corporation

Publication Date

2017-06-30

Country of Publication

Qatar

No. of Pages

4

Main Subjects

Medicine

Topics

• Patients
• Therapeutics
• Qatar
• Respiratory distress syndrome
• Extracorporeal membrane oxygenation

English Abstract

Introduction: The aim of the program was to establish a severe respiratory failure (SRF) service with mobile extracorporeal membrane oxygenation (ECMO) retrieval capability throughout Qatar.

This was achieved through the collaboration of various Hamad Medical Corporation (HMC) entities (critical care, cardiothoracic surgery, vascular surgery, and ambulance services).

The service was commissioned by the Ministry of Public Health in October 2013 in response to the emerging MERS-Corona outbreak and its associated high mortality.

After extensive team building and training, the service treated its first patient in June 2014.

The key result has been an improvement in survival rate from 19 to 68%.

The service is ranked among the best in the Extracorporeal Life Support Organization (ELSO) outcomes benchmark of worldwide SRF services.

The provision of the highest quality care to patients with high predicted mortality has given a new hope in improving clinical outcomes and their reintegration into community.

Background: In 2013, a novel virus (MERS Corona virus) was identified in Saudi Arabia, with subsequent cases in other gulf states including Qatar.1 The MERS virus was associated with rapid onset of severe respiratory and renal failure, resulting in a very high mortality rate (.50%) in the early days of the infection.2 The need to establish a SRF center with mobile ECMO retrieval capabilities was identified by the HMC senior leadership in order to anticipate and proactively deal with the situation.

The program became a matter of utmost importance due to the inevitable social, political, and geographical factors, which united the people of the GCC.

Strategically speaking, regulating the travel norms or bringing in a quarantine on travelers arriving from the countries affected by the MERS Corona virus were not a feasible alternative.3 Furthermore, the high mortality rate, failure of conventional ICU care, and the high cost of The respiratory specialists in the team were given training in pre-ECMO management and positive end expiratory pressure (PEEP) optimization along with the other important procedures like positioning in ECMO, recruitment maneuvers, and ventilation in ECMO.

The perfusionists were given training in all the technical aspects of the circuit and its interaction with the patient throughout the various phases of ECMO.

The pharmacists were trained with all the potential drug interactions in the ECMO patient interface and were given the responsibility of reviewing all the protocols for the drugs used by the GSTT team.

The physiotherapists were given training in the positioning of the patient (which can be tricky especially when they are prone) and were given the all-important jobs of resuming mobilization and exercise training of the patients while still on ECMO.

Further, they were given special training in chest physiotherapy in patients who were on ECMO, which can be very challenging, given the technology involved.

The nutritionists in the team were responsible for the total parenteral nutrition (TPN) and the interactions with the circuits.

They further were given training in enteral feeding in ECMO, which reduces the complications and the morbidity in patients who undergo successful decannulation.

The Critical Care Paramedics play an essential role in the mobile retrieval capabilities of the program, including the road map plan for activation and deployment of the team.

In our case, they had crucial input into the design of the ECMO and ambulance trolley.

The educator integrated all the knowledge and skills to maintain the competency of the team, from simple water drills all the way to advanced simulation-based competency assessment.

Up-to-date cases: The first patient was admitted to the SRF-ECMO service in May 2014 with H1N1 pneumonia and successfully discharged from the hospital after 3 weeks of ECMO therapy.

Since then, the SRF-ECMO service has treated 50 patients with a survival rate of 66% in total.

Of these patients, 25% were trauma cases.

Additionally, the SRF-ECMO service has also started its retrieval arm, moving patients from other hospitals in Qatar to the SRFECMO Center following cannulation and placing the patient on ECMO, 11 retrievals have been undertaken with one patient dying before transport.

Additionally, two patients have been transferred with ECMO to the Heart Hospital for Cardiothoracic Surgery (severe PE and thoracic trauma with bronchial tear) and one patient has been successfully repatriated on ECMO to India using our own aeromedical ECMO transfer team.

Summary: The Qatar SRF-ECMO program is one of the few programs worldwide that operates to the highest level and has been developed in less than 6 months.

This has only been possible thanks to the enormous support of the leadership, dedication of the multidisciplinary team, and the partnership with an experienced center such as Guy’s and St Thomas' NHS Foundation Trust.

Data Type

Conference Papers

Record ID

BIM-789648

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