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The São João Hospital, in Porto, is one of the institutions that has already reached the maximum capacity to respond to patients who need ECMO. The intensive care doctor of this northern hospital, Roberto Roncon, explained to RTP this Sunday morning that this limitation is due to the lack of equipment, human resources and sufficient vacancies for “covid and non-covid patients.”
The issue of limiting responsiveness is explained with the “existence of teams to treat patients – since ECMO implies the use of devices that are not available in an unlimited way” – of human resources that “have to be very differentiated” and the existence of “spaces dedicated to patients covid and not covid, because covid patients, due to the nature and transmissibility of the virus, have to be in dedicated areas (…) and therefore this also poses a limitation. “
“We currently have 15 patients with ECMO. We are one of the centers in Europe with more patients with ECMO simultaneously”said Roberto Roncon. We have to do daily management to try to manage the resources we have ”.
“We start today with the possibility of, in an absolutely exceptional case, including one more patient, if necessary and obviously that is something that, although not ideal, is at least better than not having any availability for a case. that may arise today “, explained the intensive care doctor at Hospital São João, when asked about the response capacity of this institution.
According to Roberto Roncon, if there are more cases of patients who need ECMO and the hospital is no longer capable, this problem must be “analyzed in a global context”. However, the doctor remembers that “It is not ECMO that saves lives” and it is not because there are more teams that a “much better answer” can be given.
“All the countries that have tried to generalize the ECMO technique for the treatment of these patients have had poor results”said the doctor. “The great challenge, which is a challenge that is also common in intensive care, is to be able (…) to incorporate this reality that is the seriously covid patient.”
In addition, the doctor believes that there should be “adequate screening for these patients.”
“In a pandemic context, we have to be very cold because resources are very limited”he explained, adding that “Less than five percent of severe Covid-19 patients benefit from ECMO treatment.”
Increasing the number of patients using ECMO can also increase mortality, according to Roberto Roncon, since it is a treatment “very demanding in terms of human resources and logistical resources.”
“If we want to have an excellent ECMO response in Portugal, we must first control the pandemic”, Frisou Roberto Roncon.
Covid-19 created “limitations” and increased demand for ECMO
Currently, at the Centro Hospitalar Universitário de São João, in Porto, there are 15 patients on ECMO at the same time, of which 11 patients have severe Covid-19.
Second Roberto Roncon, this hospital center “had a significant number of ECMO requests” but it was not possible to respond to some patients. In that case, the doctor explained that he contacted “other reference centers”, such as in Lisbon, and patients who need this device are transferred.
Contrary to what happened in the first wave, it is now proven that well-used ECMO treatment in Covid-19 patients can have good results. But, as Roberto Roncon explained, in recent weeks hospitals have had more requests for treatments with this device from patients with other pathologies, which increased the demand for ECMO and made it possible to reach the hospital’s response capacity more quickly. these patients.
For example,the São José Hospital in Lisbon, has already received four patients with Covid-19 from the North region who need ECMO.
“The Central Lisbon Hospital Center (CHLC) [onde está integrado o Hospital São José], is carrying out ECMO (intensive care) rescues of Northern Covid-19 patients, ”reads a note sent to the media on Saturday.
On Friday, this hospital received patients from the Peñafiel, Pedro Hispano, Matosinhos and Bragança hospitals, and on Saturday it received a patient from the Guimarães Hospital.
“We expect the lockdown to reduce pressure on the NHS in the coming days [Serviço Nacional de Saúde]”, highlighted the CHLC, “Patient management works entirely across units.”
It should be remembered that in Portugal, the Hospital and University Center of S. João, in Porto, the hospitals of Santa Maria and S. José are the reference centers for ECMO.
In RTP, Roberto Roncon stated that only at the São João Hospital there are “more patients admitted to intensive care for severe Covid-19 than other pathologies”, what worries you. In addition, there was a “need to convert a general surgery room into an Intensive Care Unit”, which he fears are not the “ideal conditions”.
The doctor added that the numbers of the pandemic do not seem to slow down or expect this to happen in the next two weeks, so the pressure from the health services continues to increase and, in particular, from the Intensive Care Units.
Also omÉdico João Gouveia, president of the Portuguese Society of Intensive Care Medicine, warned this Saturday that the arrival of more patients at the Intensive Care Units questions the response of the National Health Service to all pathologies.
“This increase in demand calls into question all kinds of responses, whether for covid or non-covid patients”, explained João Antena 1 João Gouveia.
It is essential to control the contagion, considers the doctor of the Portuguese Society of Intensive Care, which foresees more serious patients in the coming days and confirms that some hospitals have already reached the limit of the capacity of Intensive Care.
“In the coming days there will be a significant increase in patients in intensive care”He said, recalling that there are already services with the response capacity “in rupture”.
The objective is to try to increase the response capacity of the different institutions, bearing in mind that “a spirit of sacrifice, collaboration and solidarity” is needed with and between the different health institutions.
Pressure on hospitals could increase next week. The Portuguese Association of Hospital Administrators estimates that in 5 days the total number of hospitalizations can reach 4,500 patients, in the worst case scenario of an increase in covid-19 cases. 605 intensive care beds would be occupied for this pathology. This Saturday, the epidemiological bulletin revealed that 413 people with covid-19 were hospitalized in intensive care, and a total of 2798 hospitalizations.
Xavier Barreto, from the Portuguese Association of Hospital Administrators, reveals to RTP that IThis is still within the national capacity. However, this means that Beds are missing due to other pathologies. The cancellation of much of the scheduled activity would be the “direct and inevitable consequence” of the increase in new cases of covid-19 in this worst-case scenario estimated for next Friday.
More complicated surgeries can get in the way, as they always involve time in intensive care. Xavier Barreto admits that all hospitals are already reducing scheduled surgeries. For now, the non-urgent ones. “It is inevitable,” he says. An attempt is made to maintain the urgent and oncological ones.
The official talks about measures that can mitigate this scenario, such as recourse to the private and social hospital sector, inpatient units and the diversion of professionals from other specialties to intensive care (such as anesthesiologists, pulmonologists, nurses).
“Training is being provided. Perhaps not the training that would be desirable.”He admits, accusing the guardianship of not having taken this possibility into account several months ago when the association warned about it.
Again, diversion of professionals to intensive care is only possible at the cost of stopping scheduled activity.
“We believe that it would have been possible to recruit people many months ago and have trained these people”, defends Xavier Barreto, saying that this opportunity could also have been used to make Portuguese nurses go back to work in other countries with good conditions.
