Coronavirus: intensive care techniques prove vital to saving lives

Zhuang Pinghui

A 50-year-old man infected with the novel coronavirus was admitted to the intensive care unit at Tongji Hospital in Wuhan last month suffering with respiratory failure. Doctors put him on a ventilator, but his blood oxygen saturation remained dangerously low.

As the man was at a high risk of organ failure, the doctors opted to carry out a procedure known as extracorporeal membrane oxygenation (ECMO), which provides prolonged cardiac and respiratory support to people whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life.

After eight days, the machine was disconnected and the man was able to breathe on his own. Five days after that he was able to sit up in bed and feed himself. On Friday afternoon he was discharged from hospital.

The lack of availability of such life-saving techniques and equipment could be one of the reasons the death toll in Italy is so high. The country, which is now the epicentre of the pandemic, has had more than 4,032 fatalities from just over 47,021 confirmed infections – a mortality rate of about 8.5 per cent.

In comparison, China has had 3,248 deaths from close to 81,000 cases (4 per cent), while Germany has had 44 deaths from just under 14,000 cases (0.3 per cent).

Of all the people killed by Covid-19 in Italy, 87 per cent were aged 70 or above. As age is a generally considered a major factor in survival rates, there have been reports that hospitals in Italy have prioritised younger patients for emergency treatment.

Dr Zhang Wenhong, an expert in infectious diseases at Huashan Hospital in Shanghai, recently shared his experience in treating Covid-19 patients with overseas Chinese via an online event.

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“Are doctors in Italy less competent than those in Germany? I don’t think so. It’s because the number of patients needed to be treated in intensive care in Italy have surpassed the number of ICU beds available,” he said.

“The number of ICU beds in Germany is far greater than the number of patients. When treated in ICU, [the high number of] deaths in Italy is because of the lack of ventilators.”

China had about 400 ECMO machines in 2018 – according to the latest figures available – but has invested significantly in life support equipment since the start of the coronavirus outbreak.

According to US media reports, just 264 public hospitals in America had access to ECMO therapy last year. Earlier this week, US President Donald Trump invoked a 1950 bill known as the Defence Production Act to speed up the production of masks, ventilators and other equipment.

In Italy, the military is helping the country’s only ventilator manufacturer to increase production of key machines.

Germany has ordered an additional 10,000 ventilators from a domestic supplier on top of an existing order for 25,000, while Britain is asking carmakers to adjust their assembly lines to make ventilators and other emergency medical devices.

In comparison, by the beginning of March, about 65,000 pieces of medical equipment, including nearly 17,000 ventilators, had been sent to Wuhan, the city worst hit by Covid-19.

When more than 40,000 doctors and nurses from across China were sent to help in Hubei province – of which Wuhan is the capital – they took with them their own supplies, including ventilators and ECMO machines.

While ECMO can contribute to saving lives, doctors working in Hubei said it could not be widely used because it required a team of specialists to operate it.

In one case a team of 14 doctors from Beijing Hospital worked together to perform the procedure on a patient.

“The application of ECMO requires specific body indicators. You cannot put patients on ECMO just because they are a severe case. ECMO does not treat patients,” said Wang Xiaogang, a doctor with Beijing Hospital who has been working at the Sino-French New City Branch of Tongji Hospital.

“ECMO is a device to buy time for the definitive therapy to have some effect,” said Du Bin, director of the intensive care unit at Peking Union Medical College Hospital.

“I don’t believe it plays an important role in lowering the fatality rate.”

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