Notes from our meeting with Andy Burnham 8/10/2010

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?