Report calls for life support facilities for children with respiratory illnesses

Life support facilities should be provided for children with respiratory illness, an audit of paediatric critical care units has recommended.

Life support was provided on 65 occasions at the critical care unit in Crumlin children’s hospital between 2018 and 2020, the report notes, with 30 of these patients being cardiac cases post-surgery.

However, 12 runs of extracorporeal life support were required for respiratory patients, some of whom were transferred to other countries for treatment as there is no formally funded programme for them in the State, according to the report by the National Office of Clinical Audit.

“Respiratory ECMO [extracorporeal membrane oxygenation] provides life-saving treatment for infants and children with very severe lung failure. A number of these patients had a length of stay greater than 70 days in another European country, which has both financial and social implications for the HSE and for the families of these patients,” it said.

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“Although survival rates were favourable, a small number of patients died while undergoing treatment abroad.”

The report says the numbers requiring respiratory life support annually are small and the service could be provided in Crumlin for a fraction of the cost of treatment abroad. This winter, a number of children with severe respiratory illness had to be transported to Sweden for ECMO treatment because this is still not funded in Ireland.

In 2020, 68 children aged 16 or under were admitted to adult intensive care units; 40 per cent were at University Hospital Galway and 16 per cent at University Hospital Cork. More than half were babies aged under one.

Crumlin’s critical care unit is the third busiest of any in Britain or Ireland, the audit found. There were 1,399 admissions to paediatric critical care in 2020, which coincided with the start of the Covid pandemic. This was 9 per cent lower than in 2019.

About half of the admissions to Crumlin were emergency admissions and a similar proportion related to cardiac issues. The occupancy rate was 88 per cent, above the recommended maximum of 85 per cent.

The occupancy rate at Temple Street critical care unit was slightly lower, at 82 per cent, and staffing of 5.4 nurses per bed was slightly below the recommended level.

Between March 2020 and last July there were 82 admissions of children diagnosed with Covid-19 and 41 with Covid-related acute inflammatory condition to paediatric critical care units. No Covid-mortality was reported.