Last-resort treatment saves Covid-19 patient

P. BALA

It's an experience that Mr Toh Kai Kiat will never forget. The 54 year-old Singaporean, who works in the jewellery trade, was admitted to Khoo Teck Puat Hospital with fever on March 12, after returning from a business trip to Bangkok in late February. The same day, he tested positive for Covid-19.

Two days later, he was intubated and "proned" (placed on his stomach) as his conditon worsened.

As the oxygen level in his blood continued deteriorating, a National University Hospital (NUH) team was called in to Khoo Teck Puat Hospital (KTPH) on March 17 to provide Mr Toh with Extracorporeal Membrane Oxygenation (ECMO) life support treatment.

ECMO is an artificial lung machine that helps a patient with diseased lungs recover. The machine extracts blood from the body, oxygenates it artificially and then pumps it back into the body. The procedure continues until the lungs recover.

Only Singapore General Hospital and NUH carry out ECMO treatment.

When the ECMO treatment began, Mr Toh suffered a cardiac arrest because of the high pressure in his lungs. He had to be placed on a rarely used form of ECMO called venoarteriovenous ECMO. It supports the lungs and the heart.

Initially, the ECMO machine was configured only to support the lungs until Mr Toh's heart stopped beating for 16 minutes. The KTPH doctors had to perform cardiopulmonary resuscitation. Concurrently, the NUH team quickly reconfigured the ECMO machine so it could also support Mr Toh's heart. The timely intervention and the combined effort of the medical professionals kept Mr Toh alive.

Once Mr Toh's condition stabilised, he was moved to NUH for further ECMO treatment. After a couple of days, his heart condition stabilised.

Following a week of ECMO treatment, his lungs became stable enough for him to be placed on ventilator support. He was kept in the intensive care unit (ICU) where he was attended to by infectious diseases specialist Dr Jyoti Somani.

After continuous monitoring and rehabilitation for several weeks, Mr Toh was given the all-clear on April 22. He became the first Covid-19 NUH patient on ECMO to be discharged.

About 50 specialists had attended to him during his stay at the hospital. "I want to thank all the healthcare workers who took care of everything and even the emotional needs of my family," said Mr Toh. "We have to take this disease very seriously."

According to NUH Senior Consultant (Department of Cardiac, Thoracic and Vascular Surgery) Dr Kollengode Ramanathan, ECMO treatment is administered when a patient experiences severe lung infection or failure and other treatments prove ineffective. Usually, with a pneumonia condition, it takes about two weeks of treatment for the lungs to get better.

"This procedure is complex and complications can arise," he said. "You have to watch the patient's health condition closely and ensure the machine is functioning properly too. It takes a team effort to see patients through this treatment."

Dr Somani, Senior Consultant, Division of Infectious Diseases at NUH, said the challenges are two-fold: "While there is always uncertainty when we take care of very, very sick patients, with Covid-19 this is even more extreme as it is a new disease and we are still on a steep learning curve.

"While we can offer the best we have in terms of supportive treatment (including dialysis and ECMO if necessary), we do not know the most effective treatment for this disease yet and the ICU course can be very long for some patients. This uncertainty is difficult, but is to be expected for a new disease.

"Secondly, unlike most other very critical illnesses, this is one where patients are isolated from their family members. This can be heartbreaking and creates more stress, especially for the family members, and we must be sensitive to that."

pbala@sph.com.sg

X

அதற்குள்ளாகவா? இந்தச் செய்திகளையும் படிக்கலாமே!

அதற்குள்ளாகவா?
இந்தச் செய்திகளையும் படிக்கலாமே!