ECONOMYNEXT – Taking the battle against Coronavirus to a new level, doctors in Vietnam have deployed heart-lung machine technology to oxygenate the blood of elderly Covid-19 patients who cannot be saved with mechanical ventilators.
Extra-Corporeal Membrane Oxygenation (ECMO) involves taking blood out of the patient, oxygenating and pumping it back in, also maintaining blood pressure, taking over the functions of both the heart and lungs.
Heart-lung machines are usually used during heart transplants.
Patient No 19, known as Madam LTH, the 64-year old aunt of Patient 17, the first Second Wave infection who visited Italy and London, was taken off the ECMO machine, after her condition improved, Vietnam’s Tuoitre newspaper reported on April 04.
Vietnam had 16 Wave I patients in January and February 2020, all of whom recovered, including a 72 year old father of a Chinese resident, who had a history of complications.
Madam LTH was transferred to the Intensive Care Unit of the Central Tropical Diseases Hospital in Ha Noi on March 15.
Elderly Covid-19 patients in particular develop a form of pneumonia quickly. Their lungs fill with fluid, making it difficult to breathe on their own, needing ventilator support in intensive care units.
Patients on ventilators also need constant care and their survival depends of the skills of ICU nurses who suck fluid out the lungs as well doctors who keep blood pressure, saturation (oxygen level), pulse, kidney function and other vitals stabilized.
After her condition worsened, on March 19, she was hooked up to the ECMO machine.
A bigger team is needed to run an ECMO machine. Vietnam’s Ministry of Health had set up a 30-member team to monitor the condition of Patient 19, Tuổi Trẻ Online said.
They were monitoring her condition adjusting drugs and life support, every hour.
She had now made much progress and has been taken off the ECMO machine, the newspaper said.
Three serious cases, including two Britishers and a 50-year old Vietnamese lady who were on ventilators are also making progress.
Two had been taken off the ventilator. Two out of three had tested negative for SARS-Cov-2 (the virus that causes Covid-19), twice.
Madam LTH, who is off the ECMO machine had also tested negative three times, the newspaper said.
The Central Tropical Disease Hospital now has only one patient on Ventilator, an 88 year old who contracted the disease while warded at the neurology unit of Bach Mai hospital.
Vietnam has so far confirmed 239 patients, 90 had recovered and no one had died, the country’s Health Ministry said.
Vietnam has quarantined foreign arrivals, diligently chased after contacts of every confirmed patients to stop wider community transmission of the diseases.
Vietnam had quarantined over 38,000 in centres and a total of 75,000 had been either home quarantined or surgically locked down and 75,000 tests done.
Vietnam, Sri Lanka and Korea among few countries that have used contact tracing strategies and quarantine to check the spread of Covid-19.
Researchers from Vietnam have also shown how to close gaps currently practised contact tracing and quarantine strategies, in an article to be published in the news issue of the International Journal of Tuberculosis and Lung Disease (IJTLD), released online under a fast-tracking process.
The authors from the Woolcock Institute of Medical Research, Hanoi, Viet Nam; Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia, supported by others in Laos say at least three generations of contacts have to be traced and two tested to successfully kill community transmission.
T A Nguyen, Q N Cuong, A L T Kim, T N Huong, H N Nguyen, G J Fox, G B Marks, say once a patient had been identified (F0), the next generation should be tested and another two generations traced.
“First, three generations of contact (F) with COVID-19 cases should be traced to offer timely testing if the previous contact generation is found positive,” they wrote.
“This algorithm starts with the first generation (F1) who are close contacts of the index case (F0).
“All F1 contacts should be tested for SARS-CoV-2 regardless of symptom presentation.
“F1 individuals who are asymptomatic or have two negative tests 24 hours apart should be quarantined for 14 days.”
“F2 contacts should self-isolate at home and be monitored by public health units. If F1 tests positive, we recommend that F3 contacts should also be identified.
“When the previous F becomes positive, the next one will be informed to follow the contact management procedure.”
Quarantine persons should also be tested twice before being released, the researchers say.
“Inappropriate quarantine discharge could occur among patients who have an initial negative test for SARS-CoV-2 and may subsequently test positive,” they said.