Present: R. Ford, W. Ford, J. Freeman, A. Burnham, M. Farrah, J. Eddleston
On the availability of ECMO and specialist respiratory care in the Northwest:
· Jane Eddleston led the critical care network during the H1N1 outbreak, and feels the plan worked well.
· ECMO needs at least 20 cases per year in its area to justify buying and using it- especially expense of maintaining staff with the needed expertise.
· There were 150 H1N1 cases in the Northwest, over 50% in the immediate Manchester area.
· Earlier assessment and referral for ECMO use requires greater respiratory expertise than is available in the Manchester area presently. Directly relevant to Sue.
· Cases such as Susan and Gemma suffered not just from lack of expertise, but from availability: Catch 22 of well enough to travel = to healthy to justify use.
· The Cardiac care, Paediatric and Neonatal case for ECMO are well established.
· Oscillatory ventilation was found to be useful by Brampton.
· This suggests that a North West centre for excellence in respiratory care may be the way forward: A hub of expertise and technology in respiratory care, not limited to just ECMO but including oscillatory ventilation and other strategies.
· The National selection panel meets in December.
o They will decide future strategy.
o They will ask for solicitations of interest.
o Manchester can put in a bid for funding.
o There are 5 northwest centres that could be putting in a bid for funding.
o A bid for the Manchester area can be put forward.
· ECMO care can be present in this hub if the numbers of cases per year requiring it justify it.
· Mobile ECMO units? Not clear how this would work.
o A mobile unit still needs the staff with relevant skills
o These staff would not leave the hospital, meaning the unit would go, pick up the patient and return, doubling trip length!
o Necessary infra structure in the hospitals does not yet exist
Questions regarding ECMO and respiratory care:
· Why did the Caesar study take so long and why has the response to it been so long coming?
· ECMO was obtained and in use 6 months prior to outbreaks abroad. What was different here?
Questions regarding Susan’s case:
· Why she was not offered oscillatory respiration?
o Oscillatory respirator not available.
· Why was the catch 22 with ECMO allowed?
· Why could a referral not be made before her condition deteriorated too much for her to travel?
o Needed expertise not present?