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What's ECMO therapy? It saves the lives of COVID-19 patients, but the treatment can lead to higher mental health diagnoses – Vancouver Sun

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A new study by Ottawa researchers found that survivors of ECMO had a 24 per cent higher rate of mental health diagnoses after discharge compared to other ICU survivors.

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It has been called life support of the last resort, and during the pandemic ECMO, or extracorporeal membrane oxygenation, has helped pull some critically ill patients back from the brink of death.

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But treatment with the advanced form of life support appears to come at a cost for some patients, according to a new study by Ottawa researchers.

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The study, published in JAMA this week, found that survivors of ECMO had a 24 per cent higher rate of mental health diagnoses after discharge compared to other ICU survivors.

“We already knew that ICU survivors can suffer mental health impacts from the trauma of invasive treatments, living with new physical limitations and dealing with long recovery times,” said lead author Dr. Shannon Fernando, a critical care physician at Lakeridge Health and postdoctoral fellow at The Ottawa Hospital and the University of Ottawa.

“We suspected ECMO survivors would be at greater risk of mental health impacts because they are sedated and ventilated for longer and often face a more challenging recovery. But we didn’t have clear data until now.”

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ECMO, which temporarily replaces the heart and lungs of patients suffering from heart or respiratory failure, is used at five centres in Ontario, including the University of Ottawa Heart Institute.

The timing of the research is particularly relevant, say researchers, because use of ECMO grew worldwide during the COVID-19 pandemic to address record numbers of patients with severe respiratory failure. At one point, Ontario had twice as many patients on ECMO as it did pre-pandemic. It has typically been used infrequently because of limits on who qualifies and would benefit from use.

“We suddenly have a lot more ECMO survivors because of COVID-19,” said Dr. Kwadwo Kyeremanteng, co-senior author and scientist and critical care doctor at The Ottawa Hospital. “We need to make sure they have the mental health support they need to recover and survive.”

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OTTAWA – Dr. Kwadwo Kyeremanteng, co-senior author of the paper, said patients who received ECMO in larger numbers curing the pandemic need mental health support. Credit Michelle Valberg
OTTAWA – Dr. Kwadwo Kyeremanteng, co-senior author of the paper, said patients who received ECMO in larger numbers curing the pandemic need mental health support. Credit Michelle Valberg Photo by MICHELLE VALBERG /jpg

Because it is so invasive, ECMO is generally used on younger patients. About 50 to 65 per cent of those who receive the treatment survive and most are alive five years later, said Fernando.

The researchers from The Ottawa Hospital, the Institut du Savoir Montfort, ICES and the University of Ottawa studied health records from all ICU survivors in Ontario between April 2010 and March 2020. They matched 642 ECMO survivors with 3,820 ICU survivors who had similar characteristics, including age, sex, mental health history severity of illness and length of stay.

Thirty seven per cent of the ECMO survivors were diagnosed with a new mental health condition, such as depression, anxiety and traumatic disorders, a 24 per cent higher rate of new mental health diagnoses than the other ICU survivors.

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Fernando led earlier research that found survivors of ICU are at higher risk of suicide and self harm after discharge. He said further heightened suicide and self-harm risk was not seen in the study on ECMO patients, but the research calls for a greater focus on the mental health of patients discharged from ICU and especially those who received ECMO treatment.

“Patients will need help long after they leave the ICU.”

Fernando said he has cared for patients recovering after receiving ECMO treatment. Patients would frequently describe nightmares and recurrent thoughts that were in keeping with post-traumatic stress disorders.

Dr. Shannon Fernando says ECMO and ICU patients need support “long after they leave.” Credit The Ottawa Hospital
Dr. Shannon Fernando says ECMO and ICU patients need support “long after they leave.” Credit The Ottawa Hospital Photo by Supplied /The Ottawa Hospital

“It became clear it was exceedingly common.”

Knowing that can help to reassure patients, said co-senior author Dr. Peter Tanuseputro, physician-scientist at The Ottawa Hospital and ECES and investigator at the Bruyère Research Institute.

“As care providers, we can tell our patients that its common to struggle with your mental health after an ICU admission. ICU survivors need to realize that they often face months or years of recovery and families and healthcare providers need to support them.”

The full study can be found here.

For more health news and content around diseases, conditions, wellness, healthy living, drugs, treatments and more, head to Healthing.ca – a member of the Postmedia Network.

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Dedicated flu, COVID, cold clinic opens at St. Joe's on Hamilton Mountain – CHCH News

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A dedicated flu, COVID, and cold clinic opens on Tuesday at St. Joseph’s Healthcare on the Hamilton Mountain.

The clinic at the West 5th campus is intended to offer more timely care for COVID, cold, and flu patients who can’t get in to see a family doctor.

The opening of the new clinic is part of measures aimed at easing pressure on emergency departments.

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The clinic is open to both adults and children and a doctor’s referral is not required, but it’s not a walk-in clinic.

Patients are expected to make an appointment at St. Joseph’s Healthcare’s website.

The clinic can be accessed from the door beside the Fennell Ave. outpatient entrance and St. Joe’s stresses that patients must not access the flu, COVID, cold clinic through other hospital entrances or walk through the hospital.

The clinic is open from 4:30-9 p.m. during the week and from 8-4 p.m. on the weekends.

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Aid group with Canadian funding leads mission to deliver medical supplies in Ukraine

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POLTAVA, Ukraine — As the Toyota Tundra following a tractor trailer loaded with humanitarian aid heads into dangerous territory in eastern Ukraine, “Promiscuous” by Nelly Furtado and Timbaland plays over the speakers.

The small convoy transporting 20 tonnes of medical supplies is headed for Balakliya in a part of the country that was retaken by the Ukrainian army in September after six months of brutal Russian occupation. Their mission to help the devastated region crosses areas where Russian shelling continues. In Kupiansk, not far from Balakliya, shells continue to rain down.

At the wheel of the Tundra last Friday was Dr. Christian Carrer, a pediatrician from France. With his partner Tetyana Grebenchykova, he runs the Association internationale de coopération médicale, a non-governmental organization that receives support from the Canada-Ukraine Foundation and the Ontario government.

It will take the vehicles, which also include a minivan ahead of the tractor trailer, five hours to travel from a warehouse in Poltava to Balakliya, a distance of barely 200 kilometres. The roads are pockmarked from fallen bombs, and there are frequent stops at military checkpoints on guard against Russian infiltration.

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The strapping pediatrician with the face of an old adventurer has been on the ground since 2014, helping people in the Donbas region after it was invaded by the Russians. Last January, he suspected Ukraine’s menacing neighbour was planning something.

“There were strange gatherings and constant provocations,” Carrer said as he drove. “Everyone knew that clearly, something was going to happen.”

His organization started ensuring various supplies, in particular bandages, were positioned ahead of the feared assault. The last hospital received its delivery on Feb. 24, he said, the day the Russians launched their war.

“The people funding us had confidence in us because we sensed the attack,” he said.

Canada is the third most generous contributor to his group, which has also drawn donations from French, American and British sources.

The organization is well stocked and knows the terrain, and it focuses its aid in a few administrative regions in the northeast of the country. It has more than 800 items available, general or specialized medicines that hospitals and pharmacies in disaster zones can order.

Even in regions that have officially been liberated, the needs remain desperate.

The road crosses sprawling plains, and in one village after another, homes have been destroyed and gas stations and other businesses are shuttered. Crops remain unharvested in the fields. The tires make a constant purring noise as they drive over asphalt perforated by constant tank traffic.

Signs of the suffering and destruction of war are everywhere, and residents have little left to survive on. The occupiers emptied pharmacies and pillaged hospitals.

The convoy passes Chuhuiv, a municipality where the Association internationale de coopération médicale positioned medical supplies ahead of the war but that was later occupied. “The Russians took everything,” says Carrer, who has lived in Ukraine since 2006.

He describes the health condition of those who lived for weeks in shelters as pitiful, looking like “zombies.” Some are even losing their teeth, and he said visiting physicians are shocked by what they find.

As a pediatrician, he is especially worried about the state of pregnant women, young mothers and their children: a large part of that day’s delivery is destined for them.

Once in Balakliya, a desolated city with some buildings completely gutted, the aid valued at $4 million is unloaded in an old warehouse. It will later be distributed among eight municipalities in the area. A small welcoming committee includes the administrative head of Izyum district to the south, Stepan Maselski.

“This aid is very important because we are still at war,” Maselski said in an interview. “The invader destroyed our infrastructures. Just two days ago, we didn’t have electricity or water. The occupation was painful — no medicine, no medical supplies, no good food.”

A forklift empties pallets from the tractor trailer, containing cases and cases of medicine to treat chronic illnesses, epilepsy and heart problems, anesthetics for surgeries, surgical equipment, bandages, gloves, stethoscopes and diapers, among other items. There is also baby formula because infant malnutrition is widespread, Carrer says.

“Often women who give birth have trouble nursing because of the stress and the situation,” he explained. He said Ontario has provided vitamins, and the impact was practically miraculous.

There are also supply kits for those left homeless and even boxes of pet food, which is in short supply.

A special big red bag, which resembles an insulated delivery bag, is handed to Paulina, a medical official who intervenes in the provision of urgent care across the region. It is a kit conceived by doctors in California to treat people in war zones, whether for injuries caused by a landmine or for heart attacks. Paulina says the supplies are of superior quality and they are badly needed.

Suddenly the unloading operation is halted when the forklift breaks down. But the Ukrainians are creative: they tow the old forklift out of the way with a tractor — like their compatriots were often seen doing with Russian tanks on viral videos — and build a wobbly wooden ramp to complete the unloading.

Counting on Ukrainians’ ability to adapt, Carrer’s group has also delivered large numbers of warm blankets as well as small wood-burning stoves manufactured in the Poltava region for residents who have no way to heat their homes due to power outages.

Carrer says there are complex  reasons why the Ukrainian government is struggling to provide basic services in liberated territories. For one thing, he explains, the budget for health spending was cut by about one fifth to fund the war effort. And the annual provision of equipment and funding for the health system comes in February or March, which was when the Russians invaded. The number of refugees has also drained local resources.

“The needs are enormous in all the hospitals,” he says. “And now it’s serious. We see hospitals that are at the end of their tether. We used to deliver two boxes, and now we deliver whole pallets, basic supplies like plaster, gloves, cotton.”

Night falls quickly, and it is cold. The rig is empty, and it is time to leave so the group can make it through all the checkpoints on the way back to Poltava. Carrer knows his group will likely have to return soon with another load.

“Either a good soul is there to help, or they’ll call us back in a month …. We are the first to help, and perhaps the last to help.”

This report by The Canadian Press was first published Nov. 28, 2022.

— Patrice Bergeron is a Quebec-based journalist with The Canadian Press. In addition to two decades of political and general news experience, he was a CP war correspondent in Afghanistan in 2009.

 

Patrice Bergeron, The Canadian Press

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COVID-19 Outbreak Declared at Southbridge Roseview

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November 28, 2022 – The Thunder Bay District Health Unit (TBDHU) and Southbridge Care Homes confirm that the COVID-19 outbreak previously declared at Southbridge Roseview has been updated to include Cheshire and Renaissance Units only, Primrose Unit has been resolved.

TBDHU has initiated a thorough assessment of the situation. Further measures will be taken as needed to manage this situation.

Prior to the outbreak, significant measures were already in place to reduce likelihood of transmission of the virus within the facility. For additional information about COVID-19 and the TBDHU area, please see the TBDHU Website.

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For more information – Health Unit Media: news@tbdhu.com.

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