Nghe An General Hospital: Saving many critically ill patients with advanced technology

Successfully performed the 4th kidney transplant

In recent times, the technique of "taking and transplanting kidneys from living people and brain-dead donors" has become routine inNghe An General Friendship HospitalRecently, Nghe An General Hospital successfully performed another kidney transplant, bringing the total number of transplants to 4. It must be said that this is a special kidney transplant when the husband "donated" his kidney to revive his wife.

Doctors at Nghe An General Friendship Hospital perform a kidney transplant on a patient. Photo: Thanh Chung

Mr. Ho Sy Nghia (born in 1972, residing in Phu Hung hamlet, Hung Thanh commune, Hung Nguyen district) talked about the painful days due to the illness of his wife, Ms. Nguyen Thi Mui (born in 1975): For more than 2 years, my wife has been in the final stage of chronic kidney failure. In addition, my wife also has other underlying diseases such as hepatitis C, high blood pressure, anemia, heart failure... Pain, high blood pressure, and shortness of breath still come regularly. There were times when the blood pressure spiked up to 220/120 mmhg.

Three times a week, regardless of rain or shine, Nguyen Thi Mui has to wake up early in the morning to go to Nghe An General Hospital to get dialysis on time. There was a time when she felt like a burden and useless, and she thought: “If only I died, my husband and three children would suffer less. My husband alone has to work hard to take care of his wife’s medical treatment and raise three children to go to school.”

Then, a miracle came to Mr. Nghia and Ms. Mui's family. Nghe An General Hospital was the owner and recognized as qualified to perform kidney removal and transplant techniques. With great hope and boundless love, Mr. Nghia registered to donate a kidney to save his wife. And fortunately, all the tissue compatibility tests were suitable and met the conditions for kidney transplant.

Sympathizing with the wishes of Mr. Nghia and Ms. Mui's family, Associate Professor, Dr. Nguyen Van Huong - Director of Nghe An General Hospital directly made a detailed plan to carry out this kidney transplant. Accordingly, the Hospital focused on mobilizing maximum human resources, with the full participation of experts to perform the kidney transplant technique right at Nghe An General Hospital.

After the transplant, the health of Mr. Ho Sy Nghia and Ms. Nguyen Thi Mui has improved well. Photo: Tat Ngoc

In the context of the complicated developments of the Covid-19 epidemic, Nghe An General Hospital has made good preparations such as implementing protective measures for patients and donors; actively treating patients before kidney transplants... On April 19, Nghe An General Hospital performed a kidney transplant for Ms. Mui from Mr. Nghia's kidney. After the transplant, the donor and recipient were cared for and treated intensively in the Department of Surgical Resuscitation for 3 days, then transferred to the Department of Nephrology for care and treatment.

After nearly a week of treatment, the health of Mr. Ho Sy Nghia and Ms. Nguyen Thi Mui has improved. Both husband and wife can sit up and live independently. Test results show that their kidney function is normal. At this time, Ms. Mui's life has truly been reborn, freed from the pain of persistent illness. The whole family is living in joy and happiness with new dreams and ambitions.

It is known that before the fourth transplant for Mr. Nghia and Ms. Mui, Nghe An General Hospital successfully performed 3 other kidney transplants in 2020-2021. These 3 kidney transplant couples regularly undergo periodic health check-ups at Nghe An General Hospital. The examination results show that the health of the donor and the recipient are both good and integrated into daily activities.

Saving the lives of 3 “post-Covid-19” patients with ECMO technique

“Promoting the development of technical expertise, up to now, Nghe An General Hospital has performed many advanced and specialized techniques of the Central level. In 2021, the Hospital has deployed leading special techniques such as:ECMO, kidney transplant, surgery to clip the neck of aneurysms in the anterior part of the circle of Willis, endoscopic spine surgery... Up to now, thanks to early mastery of these techniques, the hospital has saved the lives of many critically ill patients. For example, with the technique of extracorporeal membrane oxygenation (ECMO) - Artificial heart and lung, the hospital has saved the lives of 3 very severe "post-Covid-19" patients" - Associate Professor, Dr. Nguyen Van Huong said.

Using extracorporeal membrane oxygenation (ECMO) – artificial heart and lung to save the lives of post-Covid-19 patients. Photo: Tat Ngoc

The latest “post-Covid-19” patient to be saved is Mr. Nguyen Duc Thanh (41 years old). Mr. Thanh was hospitalized on April 19 due to acute myocarditis complicated by cardiogenic shock with severe arrhythmia after Covid-19 infection. Medical history revealed: The patient had Covid-19 1 month earlier and was self-monitoring and treating at home. The patient had no underlying medical conditions, regularly played sports so was very healthy... On April 14, the patient developed a high fever of 39 degrees Celsius, with body aches and pains. After that, the patient had intermittent fevers, was very tired, had chest tightness, and had difficulty breathing.

After being taken to Nghe An General Hospital, the patient was transferred to the Intensive Care Unit. At the time of admission, the patient was conscious, G15, very tired, had difficulty breathing, pale lips and skin, pale extremities, pulse 138 beats/minute, blood pressure 80/50 mmHg (dobu: 10mcg/kg/minute), SPO2 85%, breathing oxygen mask 10l/minute, fever 39 degrees, little urine, echocardiogram EF 30%, pericardial effusion 5mm, troponin T 853, proBNP over 35 thousand, P/F 150. After consulting with the department leaders and treating doctors, the patient was diagnosed with: Myocarditis with severe cardiogenic shock complications/after Covid-19... The patient was intubated, sedated, ventilated, and increased doses of vasopressors and cardiac support.

After 8 hours of admission to the Intensive Care Unit, the patient's condition worsened, with progressive heart failure, lactate 9.0, oliguria, increased renal failure, high doses of vasopressors and cardiac support, escalating, echocardiogram EF 23%, pericardial effusion... Given the serious developments and high risk of death, the Intensive Care Unit organized a quick consultation at the bedside with the participation of the department's leaders, on-duty doctors, ECMO team and asked for the opinion of the Board of Directors of Nghe An General Hospital and the Intensive Care Center of Bach Mai Hospital. Patient Nguyen Duc Thanh was assigned ECMO VA.

At 11:45 p.m. on April 19, the Department of Intensive Care coordinated with the Department of Thoracic and Vascular Surgery to put the patient on ECMO VA. The patient received ECMO VA, continuous blood filtration, blood pressure control, anticoagulation according to ECMO, electrolyte adjustment, fluid balance, meropenem and vancomycin antibiotics according to MLCT, nutrition, albumin replacement, transfusion of red blood cells and platelets, inter-hospital consultation, and daily ultrasound assessment of heart and lower limb vascular function.

Up to now, patient Nguyen Duc Thanh's health has recovered well. Photo: Tat Ngoc

After 2 days on ECMO VA, the patient's condition improved, good urination, mean BP above 65mmHg, stopped vasopressors, cardiac support, stopped blood filtration. After 3 days of ECMO VA, the patient was awake, mean BP 75 mmHg. The patient was taken off the ventilator, the endotracheal tube was removed. After 5 days, the patient's heart failure improved, no arrhythmia, EF improved over 50%, good urination and ECMO VA was stopped. Currently, the patient is awake, G15d, breathing regularly on oxygen 2l/min, respiratory rate 18 l/min, pulse 75 l/min, BP 120/60mHg, SPO2 98%, urine 100 ml/h. Lactate 2.0, pro BNP decreased to 2354, echocardiogram EF 55%, ultrasound of lower limb vessels is well, no thrombus.

The success of the case demonstrates the effectiveness of extracorporeal membrane oxygenation (ECMO) in the most severe acute myocarditis. This is the third case in which Nghe An General Hospital has implemented ECMO. The successful application of this technique has opened up many opportunities to save the lives of critically ill patients in the North Central region, especially in the context of the complicated developments of the Covid-19 pandemic.