Nurses back doctors over WCH cardiac surgery unit 

29 October 2020

The ANMF (SA Branch) has backed a group of doctors calling for a cardiac surgery unit at the Women’s and Children’s Hospital – despite it being effectively ruled out by authorities – agreeing with warnings that more baby deaths could occur, on top of four in the past month, reports InDaily.

ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM told InDaily there was “a very real risk” of more deaths without a local surgery unit.

“It could give rise to significant patient care risks and concerns,” she said.

Her comments echo concerns by prominent obstetrician Associate Professor John Svigos, following a “second opinion” review released on Tuesday by SA Health, which reiterated findings from an initial review that a paediatric cardiac surgery unit should not be established in South Australia because there wouldn’t be enough cases to ensure its sustainability and safety.

Dr Svigos, who is convenor of the WCH Alliance lobby group, yesterday said: “We did not wish to participate further in this debate in public, but faced with the prospect of more deaths caused by political game-playing, we felt we had a responsibility to make our position clear”, InDaily reports.

The deaths of four babies in four weeks at the hospital were revealed in a parliamentary committee hearing last week.

The WCH faced yet another child cardiac crisis on Tuesday night with The Advertiser reporting that a four-year-old child was revived twice after going into cardiac arrest and the Melbourne retrieval team carrying specialised heart-lung bypass life support system known as ECMO was called.

It was the first such retrieval from Melbourne since a decision in July to suspend the transfers due to the COVID risk.

The Melbourne team underwent fast-tracked COVID tests on arrival before being allowed into the WCH where the patient was put on the life-support system then flown to the Royal Children’s Hospital in Melbourne for surgery.

In a statement issued yesterday, the WCH Alliance said “we disagree with the decision to not establish cardiac surgery at the WCH”, InDaily reports.

“Around 100 babies and children each year are transferred interstate for treatment. The many problems with this arrangement became apparent with the recent deaths of four babies.”

The second review by clinical experts found paediatric cardiac surgery at the WCH should not be reintroduced, but a heart and lung life support service known as ECMO (Extra Corporeal Membrane Oxygenation) should, InDaily reports.

Adelaide is the only mainland capital city without a paediatric cardiac surgery unit or ECMO services.

SA stopped paediatric heart surgery in 2002 because of low case numbers, with a recent initial review rejecting calls to reinstate it.

Babies and children are usually sent to Melbourne’s Royal Children’s Hospital for life-saving heart surgery services but due to COVID-19 have instead been going to Sydney.

The WCH Alliance said “based on our own expert information, it is clear that an ECMO (heart lung support) facility as suggested by the ‘review group’ is inherently dangerous in the absence of on-site surgical expertise”, InDaily reports.

“This is why there are no ‘stand-alone’ ECMO services in Australia, New Zealand or the UK. This danger was confirmed yesterday by local cardiac surgeon, Associate Professor Jayme Bennetts,” the alliance stated.

Ms Dabars labelled the proposal to have ECMO services without a surgical unit as “imperfect”.

“It sounds like they’re planning to have machinery or machines without the support and a back-up plan required in order to make it work, first and foremost in the interest of patient safety but also in terms of just making sure that it can operate effectively,” she told InDaily.

Ms Dabars said Dr Svigos’s concerns “should be taken on face value” and she believed “it would make sense” to establish a local cardiac surgery unit.

“We would absolutely support having a system that makes sure that patients receive appropriate and timely care locally,” she said.

Ms Dabars said the argument that there wouldn’t be enough cases in SA to make a surgical unit sustainable didn’t stack up.

“We do know equally that there are other areas that have a slim market… that they still manage to perform and sustain in SA,” she told InDaily.

“Liver and lung transplants are a small market but they still manage to perform those in SA, so one would have thought this cardiac surgery, even though it’s a slim market, should still be capable of being sustainable in SA.

“We do know that sending people to Melbourne has for a very long time been traumatic for the family of the children involved and so from that perspective it’s certainly undesirable let alone the immediacy of their treatment and care.”

Ms Dabars believes there would be “sufficient activity” locally to make a surgical unit sustainable.

“From the numbers we’ve heard… we think there would be enough activity to sustain the practice,” she told InDaily.

“The current plan the department has announced we don’t think it’s productive.

“We think it’s very imperfect and could result in significant problems. We believe it should have a proper surgical back-up.”

SA Health is conducting a review into the recent four baby deaths.