Another child heart drama at WCH sees Melbourne transfers resume
A child suffering a heart emergency at the WCH has seen the sudden resumption of Melbourne mercy flights.
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The Women’s and Children’s Hospital faced yet another child cardiac crisis on Tuesday night as controversy continues over whether it should get a paediatric heart surgery unit.
The Advertiser has learnt 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.
Just hours earlier WCH Medical Director of Paediatric Medicine Dr Gavin Wheaton told reporters discussions had started to resume the Melbourne transfers.
He said he was “very confident it was the right decision” to suspend transfers to Melbourne, after it emerged four babies had died in four weeks at the WCH with some people blaming lack of a local cardiac surgery unit and an ECMO service.
“I don’t believe the lack of a local surgical service did have any significant impact on the unfortunate deaths of those babies,” Dr Wheaton said.
A final decision on the establishment of a cardiac surgery unit at the Women’s and Children’s will be left to the hospital board, Health and Wellbeing Minister Stephen Wade says.
Two reviews have now advised against such a unit due to low case numbers, which Mr Wade noted from the reviews would make such a unit “unsafe” and lead to higher mortality rates than busier units. They have recommended an ECMO service be started.
Mr Wade said “fundamentally it is a decision for the board”, which meets next week, under his management model that has devolved power to heath network boards rather than having a “bureaucracy based in the city centre making complex clinical decisions”.
Opposition health spokesman Chris Picton accused Mr Wade of taking a “hands-off approach to this matter and a hands-off approach to running the health system”.
“Clearly the status quo has risks,” he said, noting the board would be making a decision before the results of a review into the four infant deaths was finished.
Last year a group of clinicians at the WCH put forward a business case for such a service, triggering an independent review that advised against the unit in August and to continue to fly children to Melbourne for heart surgery.
Following the deaths of four babies at the WCH in four weeks, which some people linked to the lack of such the heart surgery unit and also no ECMO heart-lung bypass service, a second review was commissioned – on Tuesday it confirmed the advice of the first report.
However proponents of the cardiac surgery unit the WCH Alliance said Mr Wade had been “misinformed” and both reviews cautioning against the unit but supporting separate ECMO service were “flawed.”
Alliance convener Associate Professor John Svigos said the Alliance disagreed with the decision to not establish a unit.
He said about 100 babies and children each year are transferred interstate for treatment and the many problems with this arrangement became apparent with the recent deaths of four babies.
Prof Svigos also warned an ECMO facility as suggested by both reviews is “inherently dangerous” in the absence of on-site surgical expertise and there were no stand-alone ECMO services in Australia, New Zealand or the UK.
“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,” Prof Svigos said.
A review into the four deaths by chief medical officer Dr Michael Cusack has now started. Three were heart patients, the fourth a lung patient, and one was flown to Sydney’s Westmead Hospital for surgery.
The cardiac surgery unit at the WCH was closed in 2002 due case numbers being too low to maintain surgical skills, and children have routinely been flown to Melbourne’s Royal Children’s Hospital.
However, a decision in July in consultation with chief public health officer Professor Nicola Spurrier stopped such transfers due to Victoria’s COVID lockdown, instead transferring children to Sydney.
Dr Wheaton said there had been no problems with delays due to stopping flights to Melbourne and instead sending patients to Sydney.
“We have ready access (to Sydney), if an operation needs to happen today or tomorrow, that’s when it will happen,” he said. “We certainly have not had any problems with excessive waits for surgery in either Sydney or Melbourne.”
While one group of WCH clinicians favoured a cardiac unit and believed it could be high quality even with low case numbers, 12 senior clinicians including unit heads signed an open letter opposing such a unit unless it can have “outcomes equivalent to national and international standards”.
