ECMO - The Covid patient who got the most intensive care
When Grant McIntyre was admitted to intensive care, seriously ill with Covid-19, the help of a ventilator was not enough to keep him alive.
The 49-year-old first went into hospital in Dundee on 26 March and within days, doctors were preparing to put him into a coma and use a machine to assist his breathing.
He says: "I was deteriorating very rapidly and I was put on to a CPAP machine within the space of an hour. As I was being anaesthetised I felt that this was going to be the fight of my life.
"I don't remember anything for the next 50 days or so. And it was only when I woke up back in intensive care here, having had my life saved by a wonderful team in Aberdeen, that I started to piece the jigsaw together."
To save his life, Grant was moved from Ninewells to Aberdeen Royal Infirmary's ICU - where a specialist system called ECMO took over his lung function for 43 days and allowed his body to begin its recovery.
Critical care consultant Ian Scott was part of the team who went to Dundee on 7 April to hook Grant up to the machine, and travelled north with him, in full PPE.
It was the ECMO unit's busiest day, with the arrival of two other Covid patients from Glasgow.
Grant was chosen as one of the very few patients who could potentially benefit from ECMO support because he was relatively young, active and had no underlying health conditions.
"If we had left him on a conventional ventilator his other organs would have started to fail," Dr Scott said.
ECMO stands for extra-corporeal membrane oxygenation.
Dr Stephen Friar, a consultant anaesthetist at the ARI, who also specialises in ECMO, says it is essentially a method of resting the lungs.
"Whenever the lungs are injured we can put a patient on a ventilator but the problem is the ventilator also damages the lungs," he says.
"You get this cycle where you get lung damage, you increase the ventilation, and you get more lung damage.
"What ECMO does is that it allows you to rest the lungs, it allows you to take the ventilation levels right down again."
The ECMO machine itself pumps blood out of the body, puts it through an oxygenator, puts oxygen in and gets rid of the carbon dioxide. It then pumps oxygenated blood back into the body.
In effect, it is removing the need for the patient to use their lungs, which can then rest and recover.
"It doesn't make a patient better but it does allow other treatments to work to the point the patient gets better by themselves," Dr Friar says.
For Covid patients, that process takes longer than usual.
The average non-Covid patient might spend a week or 10 days on ECMO. But Grant's run was 43 days - the longest stay of any Covid patient in Scotland.
"It was quite some time before there was any good news," remembers his wife, Amanda.
"Grant's journey in Aberdeen was quite a torrid one and there were many occasions when the doctors would phone with bad news, over a long period of time.
"He actually continued to deteriorate initially. There were very many dark days when the outcome was really not looking very good."
Dr Friar says doctors still do not know why the damage done by coronavirus takes so much longer to heal.
"There's an increased amount of inflammation and it just takes time for the body to deal with that," he says.
"Why it seems to be worse for some patients we just don't know. But the big thing we've learnt is to keep going and we will have some patients that will survive."
The centre in Aberdeen has offered ECMO for some Scottish patients as a satellite service for the UK network since 2009.
But this April, it took over running the service for the whole of Scotland. It was difficult timing, just as the pandemic hit.
The team had to work around the clock to take on the challenge, according to Lucy Fleming, the senior charge nurse who co-ordinates the service.
She said when London was badly hit they could see what was coming and had a bit of time to get ahead of the game.
"We didn't see it get quite as bad up here so we had a little bit more capacity but it was a busy time, " she says.
Staff on the unit usually treat only one or two patients at a time, but at the peak of the pandemic they were looking after five coronavirus cases at once.
In total, only six of Scotland's sickest coronavirus casualties could be treated with ECMO - and four of them survived.
They were selected and treated in collaboration with the rest of the UK ECMO network, including specialists in Leicester and St Thomas' hospital in London.
But Dr Friar says he believes every patient who could have benefited, got the support.
"At no point did we get to the stage we couldn't take people," he said.
"We think we took everybody that was appropriate, that would have benefited from ECMO."
Treated with steroids, Grant's lungs finally began to clear. A rehabilitation team was already supporting his recovery.
He was finally discharged from intensive care in Tayside at the end of June. But he remains in hospital receiving intensive physiotherapy and occupational therapy.
"Even at day 120 the team are still working wonderfully well together to give me the best outcome that I can possibly achieve'" he says.
As a consultant orthodontist, and professor of dentistry, Grant is determined to regain the strength in his hands and fingers.
After four months in hospital, and the support of hundreds of NHS staff, he is now almost ready to go home.
"I guess I was quite unlucky to be one of the people who has had one of the more serious ends of the spectrum in terms of the disease that I've suffered from," he says.
"But I am only too acutely aware of the people who haven't made it through and my heart goes out to their families."