Sunday, 5 February 2017

Living without lungs

At work on Thursday, several people asked me "Did you hear about the woman who lived without lungs for 6 days?!?!" Then we had a great chat about organ donation and the amazing-ness of science.

If you don't know what I'm talking about, here a summary of the story as reported by UHN:
"Melissa, then 32, was brought into TGH's Medical Surgical Intensive Care Unit (MSICU) in early April 2016, sedated and on a ventilator to help her laboured breathing. For the past three years, Melissa, who has cystic fibrosis, had been prescribed antibiotics to fight off increasingly frequent chest infections. 

As Dr. Niall Ferguson, Head of Critical Care Medicine at UHN and Mount Sinai Hospital, describes it, the influenza "tipped her over the edge into respiratory failure. She got into a spiral from which her lungs were not going to recover. Her only hope of recovery was a lung transplant.

...A team of 13 operating room staff, including three thoracic surgeons – Drs. Cypel, Keshavjee and Waddell - removed Melissa's lungs, one at a time, in a nine-hour procedure. Her lungs had become so engorged with mucous and pus that they were as hard as footballs, recalls Dr. Keshavjee. "Technically, it was difficult to get them out of her chest."  

But within hours of removing her lungs, Melissa improved dramatically. She did not need blood pressure medication, and most of her organs began to improve.

To keep Melissa alive, she was placed on the most sophisticated support possible for her heart and lungs. Two external life support circuits were connected to her heart via tubes placed through her chest.

A Novalung device, a small portable artificial lung, was connected by arteries and veins to her heart to function as the missing lungs. Working with the pumping heart, the device added oxygen to her blood, removed carbon dioxide, while helping to maintain continuous blood flow.

At the same time, another external device, extracorporeal membrane oxygenation (ECMO), which has an external pump, circuit and oxygenator for the gas exchange of oxygen and carbon dioxide, also helped to circulate oxygen-rich blood throughout her body. 

Six days later, a pair of donor lungs became available and Melissa was stable enough to receive a lung transplant in late April 2016.

"The transplant procedure was not complicated because half of it was done already," noted Dr. Cypel, "Her new lungs functioned beautifully and inflated easily. Perfect."

Did you catch the description of the lungs when they came out?  " engorged with mucous and pus that they were as hard as footballs." I think I just threw up a bit. Cystic fibrosis is the worst. We need  medication so our lungs didn't get to the point where they're filled with mucous and pus and hard as footballs. Something to think about while you watch the Super Bowl today.
While research for CF may not be at that point, it is amazing what medical advances we have made. Yay science and research funding! And hurray for doctors and families willing to take risks! But maybe it's not such a risk when there are literally no other options. When you or your family member are only a few hours from dying, I think you take whatever the team is willing to suggest. But it must've been so confusing for the family at first. "You want to just take out her lungs with no replacement?"

If your life is in the hands of a doctor, you want those doctors. At least one of them on that team also did my transplant which I was told was quite technical and required skill. I saw a few of the other doctors post-transplant in the hospital and clinic. They are some of the best.

Melissa's recovery after the transplant sounded much harder than mine after she spent 6 days in a coma with no lungs. She didn't complain about it in the interview but I read in one article that she was in the hospital for several months afterward. Her body must've felt so beat up. Plus having to wean off the ECMO machine must have been hard.

I was on the ECMO machine for a few days post-transplant to help my body get used to my new lungs and Amy kept harassing the doctors to remove it. It's important not be on it too long because the longer you're on it, the harder it is to remove. Our bodies are lazy and if a machine is going to exchange carbon dioxide and oxygen with no effort on our part, that's very easy to get accustomed to. The chances of being able to successfully wean off it are between 50 -70% (studies vary). 50% is not high!

The real key to this story is that 6 days after Melissa's lungs were removed, a set of lungs that matched her became available. The doctors don't know how long she could've remained on the machines but it wasn't indefinitely. At some point she needed someone to be an organ donor so she could live. And it happened but it very easily could not have. Unfortunately, people still die all the time while waiting for organs. I hope everyone reading the articles got the lesson to be an organ donor.

All in all, a great medical success story. 

For more information about Melissa and the surgery:

CBC's As It Happens interview 
CBC News article
Everything you ever wanted to know about the ECMO

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