31st March 2021
UK COVID Deaths – Daily 43 / 7-Day average 47
Total UK COVID Deaths within 28 days – 126,713
Total UK Deaths with COVID-19 on the death certificate – 149,168 (up to 19th Mar)
James Cook Hospital – Total COVID deaths – 609
All COVID cases within South Tees Hospitals Trust – 32
James Cook Critical Care
COVID cases – 8 (5 ventilated)
Non-COVID cases – 48 (29 ventilated)
The past week has been much calmer. As the number of patients has fallen, Nicky and I have been able to spend a bit more time at home. We haven’t exactly celebrated the easing of lockdown restrictions like a lot of the public have, but we have been able to enjoy some time together in the sunshine.
The hospital is now only using two COVID wards as the overall number of patients continues to fall. Some of our ICU patients continue to recover and have been discharged to the ward but, last week, one of our long-stay ventilated COVID patients sadly died. We had been treating them for many, many weeks but, in the end, they ultimately succumbed to their illness.
We still only have a single COVID ICU although we sometimes need to use the isolation rooms on another unit. In order to have enough beds to accommodate everyone, we are still operating an extra surge ICU. It looks like we may need this additional unit for a while longer as we have a significant number of non-COVID patients, many of whom are ventilated.
I was on-call again last night and, by the early hours of the morning, we were getting close to running out of beds. This is not that an unusual occurrence for us, even in happier times. Fortunately by the morning, a few of the patients were well enough to be discharged to the ward and we avoided having to move patients to other hospitals. None of us like transferring patients elsewhere but, during the pandemic, it has been necessary to ensure that there is always a ventilated bed for everyone.
One of the patients that we transferred out in January has only just returned to us. For once, this was not a patient that was moved elsewhere due to a lack of beds. Instead, they were transferred to allow them to receive a therapy that we are unable to provide. Our patient, who was one of the youngest patients we have admitted to the ICU during the pandemic, became rapidly unwell as a result of severe COVID pneumonitis. It wasn’t long before it was impossible for us to ventilate their lungs adequately and so they were transferred to Glenfield Hospital in Leicester for ECMO.
ECMO, Extra Corporeal Membrane Oxygenation, is a process where blood is removed from the body through large cannulas or tubes inserted into major arteries and veins, oxygenated and then returned. The ECMO machine is very similar to the machines used during cardiac bypass surgery. It pumps blood to an oxygenator that adds oxygen to the blood and removes carbon dioxide, replacing the function of the patient’s own lungs. The oxygenated blood is then pumped back into the patient’s blood vessels until such time as their lungs have recovered and they no longer need the support provided by the ECMO machine.
Of course, this is something of a simplification. There are only six hospitals throughout the UK that can offer ECMO to a very small number of adult patients. Despite the high-tech nature of the treatment, many people do not survive. Serious complications are not uncommon and the biggest risk is bleeding which can occur at multiple sites throughout the body. This is as a result of the use of anticoagulants (blood-thinning drugs) that are needed to prevent the patient’s blood clotting within the ECMO machine. There is also the risk of serious infection, strokes and damage to major blood vessels that may require amputation.
ECMO is only suitable for a tiny proportion of COVID patients. There are strict criteria that have to be met to ensure that only those patients who may benefit are considered for such a risky therapy. Sadly, many ECMO patients do not recover, as their damaged lungs do not improve enough to allow them to come off the ECMO machine and survive on a regular ventilator.
Our returning patient is the only one we have successfully transferred for ECMO during the last year. Whilst we have had seen many, many patients with dreadfully damaged lungs during the pandemic, none of them have been suitable for transfer. Our returning patient remains dependent on a ventilator but is making steady progress toward breathing spontaneously. They still have a long road ahead of them but they have defied all the odds to survive this far and we are delighted to have them return to us.