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Rare procedure for SARS-CoV-2 sufferer
Hannover Medical School (MHH) has transplanted a lung into a patient severely affected by COVID-19. For the 34-year-old, it was the only therapy still possible. After careful evaluation, an interdisciplinary team at MHH decided on the transplant in early May 2021. The patient, who was pregnant at the time of the infection, as well as her child are now doing well. "The case illustrates MHH's expertise in the care of patients severely affected by COVID-19 at all stages of the disease," Professor Dr. Frank Lammert, Executive Board member for Health Care, points out.
Child delivered by cesarean section
In early March 2021, the pregnant patient had been admitted to MHH with a COVID-19 infection. Her stable condition deteriorated visibly over the course of a week: after an initially successful week of non-invasive mask ventilation (NIV), she had to be intubated and artificially ventilated due to advancing lung failure. Immediately after intubation, the intensive care physicians, together with Professor Dr. Constantin von Kaisenberg, Division Head of Prenatal Medicine and Obstetrics at the MHH Department of Obstetrics and Gynecology, and the neonatologists at the Children's Hospital, decided to perform a cesarean section at the 34th week of pregnancy because they expected the mother's health to deteriorate further. There was already a very good chance of survival for the child outside the uterus. In addition, the doctors expected that the patient would be easier to ventilate after cesarean section and that treatment with an artificial lung, extracorporeal membrane oxygenation (ECMO), would be more promising.
Infection irreversibly damaged the lung
The decision turned out to be correct only a few days later. The condition deteriorated so rapidly that an artificial lung (ECMO) became necessary to provide the patient with sufficient oxygen. Due to massive and irreversible damage to the lungs, the intensive care physicians, together with the pulmonologists who were called in, finally examined whether a lung transplant could be considered as the ultima ratio. "The patient's lungs were very badly damaged by the infection. There was no longer any prospect of the lungs recovering despite all intensive medical measures," says Professor Marius Höper, M.D., vice director of the Department of Pneumology. "That's why, after careful evaluation, we ultimately decided on a transplant together with the intensive care physicians and surgeons."
Artificially ventilated with ECMO for 40 days
To evaluate the patient for transplant, she had to be responsive. "Often patients are sedated when they are artificially ventilated," explains Professor Wolfgang Koppert, M.D., director of the Department of Anesthesiology and Intensive Care Medicine. "In a total of nine weeks, the doctors, nurses and physiotherapists on Ward 44 worked hard to ensure that the patient could be awake and thus responsive during artificial ventilation." In total, the patient was dependent on artificial lungs (ECMO) for more than 40 days.
In addition to irreversible damage to the organ, other criteria had to be met before a transplant could be performed: she could not have any relevant previous diseases that could have threatened the success of the transplant, and she could no longer have an acute COVID-19 infection. "Our criteria for listing the patient were that she had no neurological deficits, no damage to other organs, and could comply with the lifelong therapy associated with the transplant," says Professor Axel Haverich, MHH Director of Cardiothoracic, Transplantation and Vascular Surgery and Head of the MHH Transplant Center, "The patient met all of these."
Interdisciplinary expertise at MHH
The patient's care involved physicians, nurses, physical therapists and perfusionists from numerous disciplines - from intensive care physicians and pulmonologists to the women's and children's clinics, surgeons and anesthesiologists.
"The situation was completely different from what usually happens in lung transplantation, where patients are usually evaluated over a period of six months and are able to deal with the situation mentally during this process," explains Professor Höper.
Mother and child are now doing well
For patients whose lungs are irreversibly damaged after COVID-19 infection, transplantation may be the last therapeutic option. To date, about 40 of these patients have received lung transplants worldwide. Three additional cases are known throughout Germany. "In the COVID-19 transplants performed so far, it was reported that the damage to the lungs had made the operation more difficult. However, this was not the case with our patient," explains Professor Dr. Haverich. "The surgery proceeded without further complications. The patient also did not need to be artificially ventilated with ECMO again after the operation," says the surgeon. "After only a few days, breathing started spontaneously." Two weeks after transplantation, she was able to leave the intensive care unit. The transplanted lungs are fully functional. "There is a good chance for a full recovery." Mother and child are now doing well.
SERVICE:
For more information, contact Professor Axel Haverich, 0511 532 6580, Haverich.Axel@mh-hannover.de, Professor Marius Höper, 0511 532 3530, Hoeper.Marius@mh-hannover.de, and Professor Wolfgang Koppert, 0511 532 2489, Koppert.Wolfgang@mh-hannover.de.
In the picture, you can see some of the doctors and nurses involved in the patient's care, represent ...
Source: "Karin Kaiser/MHH".
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In the picture, you can see some of the doctors and nurses involved in the patient's care, represent ...
Source: "Karin Kaiser/MHH".
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