After 26 days in SGH, 19-year-old survives H1N1 with respiratory ECMO support
Singapore, 15 October 2019 – A post-exam getaway for then 19-year-old Heng Wee Heng last December nearly cost him his life had he not returned to Singapore before his condition worsened. He was running a fever, coughing and feeling lethargic -- symptoms of a common cold -- while travelling through Europe with his brother. Little did they know that Wee Heng had caught something more sinister.
Wee Heng’s condition did not improve despite seeing a GP upon returning to Singapore. A few days later, he was admitted to a public hospital’s Intensive Care Unit (ICU). He had severe breathlessness, fever, and his fingers were turning blue. But hours later, a multidisciplinary team from the Singapore General Hospital (SGH) and National Heart Centre Singapore (NHCS) was activated to put him on respiratory ECMO, a life support machine, before transferring him to SGH’s Medical ICU (MICU).
Wee Heng had severe respiratory failure caused by H1N1 influenza and was on a mechanical ventilator as he was unable to breathe properly. Despite this, the oxygen level in his blood continued to plunge to critical levels, which put Wee Heng at risk of more complications and even multi-organ failure. Hence, the SGH respiratory ECMO team was called in.
ECMO (Extracorporeal Membrane Oxygenation)
For patients like Wee Heng who fail to respond to conventional mechanical ventilation support, ECMO (or extracorporeal membrane oxygenation) can be a life-saving option as it takes over the heart and lung functions to allow the underlying disease like infections and injuries to be treated.
Patient is connected to the ECMO machine via tubes inserted into their large veins or arteries by cardiothoracic surgeons. The machine then pumps blood from the patient’s body through an artificial lung where oxygen is added and carbon dioxide is extracted before pumping the blood back into the patient.
Patients may be put on ECMO for several days to weeks depending on their medical condition. Not every patient is suitable for ECMO as they face possible complications such as bleeding, infection, and stroke, which can be minimised under the close watch of an experienced team.
Respiratory ECMO Team
Led by SGH respiratory physicians, the respiratory ECMO team comprises ECMO-trained ICU nurses and respiratory therapists. The team is well-supported by other medical professionals in the MICU who also monitor and care for patients on ECMO.
“Studies have shown that patient’s survival can be improved if they are transferred to and cared for by a dedicated ECMO team in a specialised respiratory centre. The ECMO team is very involved in the day-to-day management of these critically ill patients. Effective teamwork and leadership are critical, considering how quickly the condition of an ECMO patient can change,” explained Dr Sewa Duu Wen, Director, MICU, and Consultant, Department of Respiratory and Critical Care Medicine, SGH. He is also Wee Heng’s doctor.
The team has cared for 110 patients since respiratory ECMO was first introduced in SGH in 2009 for H1N1 influenza patients. They are also consulted frequently by medical teams from other public and private hospitals in Singapore. If their patients are assessed to be in need of and suitable for ECMO, the team and cardiothoracic surgeons from NHCS will make a trip to the hospital and put patients on the life support machine before transferring them to SGH, which has the largest ECMO service locally.
Patients on ECMO typically have lung infections caused by viruses. The H1N1 and other types of influenza viruses can be avoided with a simple flu vaccination. Yet, the annual vaccination is overlooked by many, including mothers-to-be and the elderly, who are at higher risk of getting severely ill from flu.
“Influenza is highly contagious and potentially deadly. Even though ECMO has improved the chances of survival of patients with severe influenza pneumonia, prevention is better than cure. The best way to protect yourself and your family from the flu is to get a flu vaccination each year,” said Dr Phua Ghee Chee, Head and Senior Consultant, Department of Respiratory and Critical Care Medicine.
Wee Heng has since recovered and is currently pursuing an engineering degree at the National University of Singapore. To avoid reliving the nightmare, he has gotten himself an influenza and pneumococcal vaccine – something which he had never done or considered.
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