61-year-old affected person suffered from extreme post-COVID-19 respiratory failure after three months on a synthetic lung that oxygenates blood and a number of treatment-related problems.
Medical doctors in Lisbon report on the case of a 61-year-old man who acquired a double lung transplant after his lungs have been irreparably broken by COVID-19, in a case report offered at Euroanaesthesia, the annual assembly of the European Society of Anaesthesiology and Intensive Care (ESAIC), held on-line this yr on December 17-19.
The affected person contracted COVID-19 in January, 2021, and was discharged from the hospital on August 23, marking the Centro Hospitalar Universitário Lisboa Central’s first profitable lung transplant in a COVID-19 survivor.
The person, who had a historical past of dyslipidemia (unusually excessive ranges of ldl cholesterol and different fat within the blood) and gastritis (irritation of the abdomen lining), was admitted within the emergency division with SARS-CoV-2 pneumonia on January 12, 2021.
Regardless of help from a ventilator, he deteriorated with extreme breathlessness as a result of low oxygen ranges and required the superior lung help remedy, extracorporeal membrane oxygenation (ECMO)—which fully takes over the operate of the lungs. He spent 74 days on ECMO earlier than being switched to extracorporeal carbon dioxide removing (ECCO2R)—a tool designed to take away carbon dioxide however doesn’t present such a excessive stage of oxygen.
Throughout these three months, he suffered a number of infections together with pneumonia and prostatitis (swelling of the prostate gland) in addition to blood problems together with a blood clotting dysfunction (ECMO-associated coagulopathy) and a life-threatening response to the blood-thinning medicine heparin (heparin induced thrombocytopenia).
“About 75% of the affected person’s lungs had been scarred by COVID-19, and it was clear from his scans that his lungs have been completely broken, and wouldn’t get better,” says anesthetist Dr. Carolina Almeida from Centro Hospitalar Universitário Lisboa Central, who was a part of the group who carried out the transplant. “The affected person certified for transplant as a result of he was younger and robust sufficient to outlive the dangerous procedures, and no different organs had been impacted by COVID-19. After cautious scientific analysis, he acquired the life-saving organs in Could.”
The surgical procedure took about seven hours and concerned two weeks of post-operative intensive care.
It has been six months for the reason that transplant, and his restoration is in no way full. His lung operate is sweet and he now not requires daytime oxygen help, however he has needed to overcome quite a few challenges on the restoration journey, together with atrial fibrillation (irregular coronary heart rhythm), a collapsed lung, subcutaneous emphysema (wherein air turns into trapped underneath the pores and skin), sort 2 diabetes, and several other infections.
He continues to obtain rehabilitation to enhance his mobility, lung operate, and high quality of life, and must take greater than a dozen drugs for the remainder of his life to stop organ rejection and infections.
“The group is massively grateful that the surgical procedure went so properly and that the affected person made it house to proceed rehabilitation near his household,” says Dr. Lurdes Castro, a senior anaesthesiologist from Centro Hospitalar Universitário Lisboa Central who helped carry out the transplant. “It requires monumental willpower to beat all the things he has endured, and it’s fantastic to have performed an element in giving this affected person the chance to dwell once more and return to his household and former life.”
The primary small case-series of early outcomes after lung transplantation for extreme COVID-19 was revealed in Could 2021. “Lung transplantation is a lifesaving therapy for a rigorously chosen group of COVID-19 sufferers whose lungs have been irreparably broken by the virus and who’re sturdy sufficient to endure main transplant surgical procedure,” says Dr. Almeida. “However given the impression of COVID-19 worldwide, and the rising variety of youthful, more healthy sufferers affected, the variety of transplant candidates is more likely to enhance significantly. That quantity might develop to incorporate COVID-19 survivors whose lungs might deteriorate over time.”