In Scotland, there is a unique team at the heart of the National Health Service. Hi there. Can I give you a heads up call for a pediatric transfer? The pediatric retrieval service is an expert squad of dedicated men and women. Ready to go. >> They're highly skilled doctors and nurses who work around the clock to transport children from all over the country into specialist care units. Whether on the road or up in the air, it's a race against time to get children the medical care they need. And for the first time ever, they're allowing the cameras to follow them. In this episode, a 21-month-old boy from Belfast and his desperate fight for life. >> We need to improve the baby from a respiratory point of view. hopefully and then go on to repair the cardiac defect. >> The retrieval team head to Wishaw for a 5w week old baby who's struggling to breathe after a viral infection gets serious. >> This one's about 5 days into their illness, maybe even a little bit longer. So, a little bit unusual that things have gotten worse at this point. >> And unexpected bleeding following a cleft pallet operation results in a 21week old baby being brought in from Inesse. The National Health Service looks after the health care needs of children across the whole of Scotland. Rural hospitals and health care professionals provide a vital service to local communities. But in the most serious cases, children need to be moved quickly to major intensive care units in Glasgow and Edinburgh that have the most advanced medical technology. It's midday and a critically ill child from Belfast has just arrived in Glasgow's York Hill Hospital. >> Can I Nile has been struggling with a viral lung infection which is further complicated by the fact that he also has a heart condition. He was flown here from the children's hospital in Belfast by the pediatric retrieval team. >> This is a little boy who's been in Belfast Children's Hospital since the 29th of January. The child has had a respiratory infection which has been an ongoing but that is also compounded by the fact that the baby has a cardiac condition. So there has been some discussion about the baby requiring cardiac surgery as well as um coming to ourselves for ongoing respiratory management. >> I would start at 100% and then work it back. It should be hopefully you'll get him back to about 60 to 70%. >> Okay. >> But um we're still going to read it. >> Even on a ventilator, Nile's oxygen levels or SATs are critically low. >> So that's 25 on 13 25% oxygen. Dr. Lions from Belfast has been using a hand ventilator as this has been the only way to deliver enough oxygen to baby Nile. Each pump is sending oxygen directly into his lungs. >> I just have you bolising back or was he on? >> Well, we were on the trip but he was on an in. >> No problem. That's absolutely fine. >> Nurse practitioner Edith wants to transfer him onto the hospital's life support system as soon as possible. Right. One, two, three. >> The transport team complete the handover to the intensive care staff. It is critical that the team are aware of all the facts relating to Nile's condition. >> Can I have a saturation on at least so that I can see what's going on? >> Nile has been brought to York as the hospital has a specialist life support machine. However, the first priority for the team is to stabilize his oxygen levels. This has happened on two occasions since I I've been having to bag him. >> We we had him down to an FiO2 of about 70 and baseline sets in the high 80s. Um we were accepting anything in the 80s, but at the moment what he's doing is dropping right through the 80s. He's he was >> basically he was good on the plane. We were we were saturating in the '9s on 80% in the plane and on the change over the movement back into the ambulance some he's he's done this a bit behind as well. It seems to be shifts. The plugs are he's very thick secretions and he must be plugging off areas and and when he does it um we've we've ended up with we've usually cured it with with suction is is what's gone but um two there >> when he arrived he was having episodes of desaturation. Now that can be related to coming out of an airplane and we were going into an ambulance. So you're changing actually what support you can provide to that baby. But the things that were happening were not a cause of the transfer. They were a cause because Nile's condition has been so poor and critical. Um so the medical staff that brought the child over from Belfast did a wonderful job and we're coping very well, but it was just the transition from going from their ventilator onto our ventilator that made it a bit precarious initially. But the baby has now stabilized down again to the condition that he was in prior to to leaving Belfast. >> Nile has now been fully transferred to the hospital system and Dr. Lions and nurse Vivian Lily can return to Belfast, but they'll maintain close contact with Yorkill see how Nile is progressing. Working out the next step for a baby with complex breathing problems and a critical heart condition isn't going to be straightforward. See you later. >> A call has come in from a hospital 20 miles from York Hill. A 5-year-old baby with a viral chest infection is struggling to breathe. >> Dr. Cheryl Gillis and retrieval nurse Janet are on their way to collect him. It sounds as if from the story I've heard that um this we one's about 5 days into their illness, maybe even a little bit longer. So, a little bit unusual that things have gotten worse at this point, but not unheard of. You always go into these situations with a little bit of um trepidation for for lots of reasons and I think probably rightly so. um you're always out of your own environment when you're on transport and you're potentially working or meeting people in terms of other teams there that you may or may not have worked with before. Um as much as you can get as as full a picture as possible over the phone, you also don't have your own personal feel for the clinical situation with the child that you're going for. Um so there's always a a slight element of you're not you don't really know what's what's going to meet you when you're out there. Baby Zach was admitted to Wishaw Hospital 5 days ago. Under advice from Dr. Cheryl and other intensive care doctors in York Hill, he's been put on a ventilator. Cheryl won't fully know whether he's stable enough to be transferred until they get there. In Edinburgh, retrieval doctor Nandita is on the phone to ambulance control. A baby in Inesse who has recently undergone surgery has begun bleeding from his mouth. The local medical team were concerned and called the retrieval team. >> No, it's a 5-month old child. >> Baby Max recently had an operation on his mouth and a large bleed like this presents a serious choking hazard for such a young child. >> So, this child has had a cleft lip and pallet repair about 10 days ago and is now bleeding from there. So, it's basically bleeding from his mouth. The baby is able to be flown if uh but depending on how how what's the time scale for the plane and things is >> he's in the hospital in Rigmore but he needs to come here um just for further management really. Nandita and nurse Allison prepare their kit for the transfer from Inesse to Edinburgh which will be done by road because the only available plane has been booked for another emergency >> various other bits and pieces that we need to take. So uh we've got our own retrieval telephone. We also carry a satnav which we can give the parents just so that they can find the hospital. We've got sort of specific drugs that we take with us. So that's really it. Just just all the kid that we will possibly need. With a 6-hour round trip ahead is going to be a long night. The Yorkhill retrieval team have come to Wishaw. Baby Zach has a viral infection but has taken a turn for the worse and is struggling to breathe. >> Janet, I've reviewed the X-ray and I just feel that chip could come back just 1 cm. I just don't want it slipping down the right lane on our way. >> Dr. Cheryl Gillis has decided that Zach is stable enough to move. But first, she needs to ensure that the tube connecting him to the ventilator is secure. Air entry is just maybe not quite so good on the left. I think pulling the tube backs maybe a good idea. It was just sort of sitting just above the keeping everything safe for transfer. The the best thing to do is just to pull the tube back a little bit. make sure that we're then happy it's in a in a as good a position as we can possibly get. >> There we go. >> Okay. Okay. So, we're 13 at the hub, which means we're just about 12 at the lips. I'm just going to pull back the 1 cm. So, that should be us. That's 12 at the hub, and that should be about 11 at the lips. And it just if you've got you hold on that as well there Janet just so it doesn't slip. No, that's better. Good. >> With Zach now ready for the transfer to the Royal Hospital for Sick Children in Glasgow, Dr. Cheryl brings in his parents. >> Hi guys. Come on and see. I told you we'd be all cozy, didn't I? So that's him all cozied in there. He's doing just fine. I'm just waiting on the result of a we blood gas test coming back just to tell me that everything's okay with the ventilation. Um, as you can see, he's nice and cozy. And when we're ready to go, we'll just pop up the we glass sides, but we can get into him if we need to do anything. >> That's interesting stuff. That's >> Are you managing that? Okay. >> Baby Zach is wrapped up and ready to go. It's just a 20inut journey to the intensive care unit in Glasgow. >> Okay. Thank you. 21-month-old Nile was transferred from Belfast Children's Hospital a week ago. He's struggling with a chest infection and has a hole in his heart. His condition has been further complicated by a bowel infection that required surgery. To aid his recovery, doctors have placed him on ECMO, a machine that oxygenates his blood outside his body. It's one of the most advanced life support systems available, but the medical team is increasingly concerned about Nile's condition. He's under the care of Dr. Alistister Turner. Unfortunately, a couple of days ago, Nile had an episode where his tummy became very swollen. We performed some tests which suggested there was fluid inside his abdomen. Unfortunately, that required him to have a laparottomy. That's an operation on his tummy. and we discovered that a large part of his bowel was unfortunately infected and necrotic. That means part of the bowel had died. Uh this requires him to have part of his bowel removed which was performed in the unit whilst he was on ECMO. So that the surgery has meant that he has had to have what's called a sto formed. That's where part of his bowel has been taken out into his abdominal wall. And it will mean that in the future he'll require further surgery to try and uh put the two ends of his bowel back together again. N's prognosis remains still very guarded. By that I mean we really don't know how this is going to end. He may recover but there's still a very real possibility that he may die as a result of this. >> They will continue to monitor Nile very closely. >> I mean he's still getting a decent contribution from his own lungs which are getting better. >> Question is whether we actually do anything about it. >> Dr. Dr. Neil Spencley has noticed that the blood in Nile's ECMO circuit isn't as oxygenated as it should be. >> If the actual volume return the preload to the canula is reduced if it's gone down the vein rather than the >> Dr. Neil suspects the tube or the canula inside his body has moved. He decides to call surgeon Dr. Carl Davis to discuss whether it should be repositioned. his sats, his pa2 um and his uh um Venus sats are are good. So my question is, do we actually should we be thinking about repositioning it? Um my sense is not at the moment, but it was really just to let you know that that might be an option if we run into oxygen delivery problems. What do you think? So the discussion was do we actually do anything about the far away part of the canula that's flipped from one very large vessel to a smaller vessel. Um and he agrees that actually it's a bit of a rigma roll and a surgical operation to actually correct that. Quite often if this happens it might it's flipped in from a larger vessel to a smaller vessel. It might just easily flip back again. The main thing is is the combination of the oxygen going into his body from his lungs and the oxygen going into his body from the ECMO circuit combined is that sufficient to provide enough oxygen for his body. And the answer is probably yes at the moment. So the plan is to hang fire, but we've alerted the correct people to do something about it um and attend later on should we run into a problem. Fiveweek old Zach has a viral infection that has developed into bronchulitis. 3 days ago, Dr. Cheryl retrieved him from Wishaw Hospital as he'd been struggling to breathe. >> Right. We almost ready. Good. >> He's been on a ventilator in the intensive care unit since he arrived at York Hill. Dr. Cheryl has decided it's time to take him off the ventilator. >> We can see he's made good progress and he's actually ready to have his um his breathing tube out um and to see how he gets on with that. One of the main reasons we intubated Zach over in Wish on the first instance was because he was having pauses in his breathing. Um and he certainly doesn't seem to have been doing that quite so often with us while he's on the ventilator. Albeit that it's a bit more difficult to tell when he's getting the support. Um has he been needing a lot of regular? As all babies react differently, the medical team won't know whether Zach will need any more assistance with his breathing until they remove the tube. >> If it sounds as if he needs a we suction, we'll suction first before we take the >> Dr. Cheryl makes some final checks to ensure that everything runs as smoothly as possible. Right, young man, let's just pop you onto this bag here. Sounds already like you might have some secretions. Usually we'll keep a baby fasted for about 4 hours before we we take the tube out in preparation. So we've done that with Zach this morning. Um we make sure again that our ventilator is at a a low rate, a kind of support rate that we think that the baby will cope. And I've checked that with with Zach this morning. We've reviewed his chest X-ray to make sure there's no changes that that might not help when he gets the tube out and might kind of hold him back a little bit. And again, that all looks very good. It's not uncommon for them to be a little bit horsearse after the tube comes out just because of the irritation from around the vocal cords, but that's something we'll keep a keep a close eye on. Lovely. Right, darling. Oh, wait. Do a we bit of gentle suction in around your mouth. That's fine. Might want to cut that to a bit of a narrower part just to make sure it stays on. Well, good lad. Dr. Cheryl uses a suction tube to clear any blockages so that Zach can breathe more easily. So what we're doing here is we're just delivering 4 L per minute of um humidified flow which is both aid and oxygen. And we've got about 40% oxygen um just to support his his oxygen levels. And the the flow provides a little bit of support for the for the breathing as well. But it's also nice because it's humidified, so it doesn't dry up their secretions quite so so badly. And what I always like to do is once we've taken the tube out, just like to stand back and watch for a few minutes just to make sure that everything's going to go to plan. Just take sweetheart, let's have a look at you. Okay, beautiful. Certainly looks all right for the moment. Dr. Sher was satisfied that Zach is coping well after being taken off the ventilator. Over the next few hours, the medical team will keep a close eye on Zach to see if his condition improves enough for him to be moved out of intensive care and onto the ward. >> 5-month-old Max from Inesse was brought to Edinburgh's Royal Hospital for sick children last night. He was bleeding from his mouth following surgery to repair a cleft pallet. He's been on the high dependency ward overnight and his mom Mari is by his side. The first bleed happened at home and it wasn't a a bad one. It was just a quite a small one from his nose. The second one was from his mouth and there was a huge amount of blood second time around and he swallowing it and choking and blood everywhere which wasn't very nice. Um when we spoke to the surgeon, she said um we'd probably be kept in for about a week. Um possibly longer depending on whether he has any further bleeds. Um they're just going to monitor him and obviously check his mouth and make sure that there's no burst stitches or or any further bleeding. Um and also from his nose as well, cuz that was one of the bleeds yesterday. So assuming that's all okay, then everything else should be fine and we'll get home. >> The Children's Hospital cleft pallet specialist, Dr. Felicity Mahendale has been caring for Max. >> Sometimes if there is a really nasty bleed, surgery is the answer, but it that wasn't the case with Max. It settled. So again, it wasn't like it was a blood vessel that had suddenly broken down. It did seem like it was something that caused it to bleed and that had settled and he was he was fine. So he didn't need surgery. We kept him on the medicine that helps his blood clot a little bit more. It's a good medicine. and we use it quite frequently and it just makes so if he'd rubbed or poked his pallet um a bit like scratching a scab, you don't you want it to be undisturbed and you want the clock to stay there and be stable. But he's doing well. >> Baby Nile is gravely ill. He was transferred from Belfast to Glasgow by his local transport team 7 days ago. >> He's been struggling to absorb enough oxygen due to a bronchulitis infection, but he also has a hole in his heart. >> The Glasgow team put him on to ECMO, which oxygenates his blood outside his body, giving his lungs a chance to recover. However, there have been further complications. He had surgery on his bowel which isn't healing properly. >> So at the moment Nile's on multiple organ support. He's on um some uh renal support, some support for his kidney with a machine called um CVVH, which is a type of dialysis machine. That's basically because although his kidney is working, it's not quite working fast enough to clear all the excess fluid that's been distributed in the wrong place around his body. So, I think for now we're still very much taking things day by day. I think um I'm hopeful that by the start of next week we'll be off the ECMO machine that we'll be using less of the CVDH renal support and starting to rely on his own native organs, so his lung and his kidneys to do more of the work and that the surgeons will have been able to get his abdominal wound closed. and that once that happens, we can give him less blood products and hopefully then his jaundice will start to to get better. The team has been waiting for the results from blood tests to see if Nile's gas levels have improved enough to consider taking him off ECMO. Dr. Colin Beg has just received the results from the lab. So Nile's carbon dioxide levels are still quite high, which indicates his lungs are still not quite ready to come off of the ECMO machine. And I think rather than limping off today and having to push his lungs too hard, we'll give him another 24 hours try to clear some more fluid from his system with the uh CPVH machine. And then we'll we'll we'll try again tomorrow. Is that okay? >> After a viral infection developed into a serious illness, baby Zach spent 5 days in the care of medics at Yorkill Hospital in Glasgow. Zach is now back where he belongs, in his mother's arms. >> What? 5 days ago I didn't even have a smile on my face and now I have some when I seen him in the Friday morning it was horrible and I just thought they tell me it was RSV it's only a cold until I seen him it's a common cold to anybody like adults and that but it because he has age it hurt him really really bad and when they told me it's time to put the machine on for came to breathe for him. I was think he's not going to be here. So that's when it hurt me. This is really serious really. Like how can a cold cause this? But it's wonderful. No. >> The retrieval of baby Zach went pretty well in the end. Um, Zach's gone on to have really quite a nice course with us in ICU. Um, after after he was admitted, he was kept ventilated for a couple of days, but we were able to wean that support steadily and and as you saw, we were able to extubate him um just a couple of days ago. Um, after taking the tube out and having him on the high flow nasal canul oxygen, he did really really well. We were able to wean down that support really quickly. Um and in fact he was able to be discharged um just the next day in fact up to the the ward upstairs just on a tiny trickle of oxygen um and managing his feeds through an NG tube. So overall pretty pleased with how his admission went and having spoken to the ward that having had quite a a a straightforward run with ourselves in PICU he was actually discharged home from the ward um the next day and has obviously done really well. So those are the kind of cases that we that we like to see here and um you know it's a really nice to see that outcome um and to see him getting over his illness having been treated appropriately and and being able to get back home with his mom and dad. It's been 6 months since baby Max left the Royal Hospital for sick children in Edinburgh. He had a worrying bleed in his mouth following a cleft pallet surgery. His mom Mari remembers the retrieval well. >> The pediatric team were amazing. They were very calm. They stabilized him quickly and all the way down in the ambulance, they kept him calm and settled and reassured me as well. Um and then yeah, it was just a quick transfer into the intensive care unit when we got there and various doctors came and did some checks and he was monitored um for another 7 days before he was released. um he didn't have any further bleeds so they felt it was safe for him to go home after that point. He's had another operation since then and he's recovered amazingly well. He was out within the 3 days and yeah smiling and happy again within a few hours. So it's good. >> As he grows and develops, Max will continue to receive care from the cleft lip and pallet team. We'll keep Max under followup till he's 20. Um to make sure that as he grows, his pallet continues to work well, his jaw continues to grow, and he's happy with things. He when he's older, he'll be a teenager. He'll know his own mind. He'll tell us what he wants, and within reason, we'll try and do it. >> 21-month-old baby Nile spent a month in the intensive care unit at York Hill. A viral infection placed a strain on his heart and lungs which were already weakened. Despite the best efforts of the medical team, Nile didn't recover. His parents have given their consent to allow his story to be broadcast. The pediatric intensive care units in Glasgow and Edinburgh treat hundreds of children every year. Hello. >> It's a very sad reality that not every child can be saved.