After being on artificial lung support for more than a month despite a lung transplant woman gets new lease of life

First time in India, a patient was kept on artificial lungs post lung transplant and recovered successfully by the doctors.

By: Debjani Arora | | Published: August 17, 2018 12:24 pm

A team of senior doctors from Fortis Malar Hospital successfully conducted a high-risk bilateral lung transplant on a 28-old lady from Mumbai. It is a clinical feat when Ms Nazanin Zuber Patel recovered from a month long ECMO procedure, a first in India. ECMO stands for Extracorporeal Membrane Oxygenation, which means outside of the body. A membrane oxygenator is a piece of equipment which acts as a lung to deliver oxygen into the blood is attached to the patient. The ECMO circuit acts as an artificial heart and lung for the patient during ECMO therapy This challenging feat was achieved by a team of doctors led by Dr K R Balakrishnan, Director, Cardiac Sciences and Dr Suresh Rao KG, Head of Department, Critical Care & Cardiac Anaesthesia, Fortis Malar Hospital.

The case

The patient Ms Zuber was admitted in Fortis Malar hospital with complaints of severe breathlessness, abdominal pain along with vomiting and a diagnosis of primary pulmonary hypertension. She was suffering from hypertension since 2008. The pressure in her lungs was 140 mmHg, as compared to a normal value of 25 mmHg. Her heart pumping was severely compromised, especially the right ventricle which was pumping only at 15% capacity. She was medically stabilized and waitlisted for a bilateral lung transplant.

On the 8th of February 2018, a potential donor was available, and the transplant was performed. Post-transplant, the patient had persistent hemodynamic instability (low blood pressure) and hence IABP (Intra-aortic balloon pump) was inserted. Nazanin was administered life support VA ECMO (veno arterial extra corporeal membrane oxygenation) when her hemodynamic instability continued. Once her hemodynamics improved she was put on VV ECMO (veno venous ECMO) as her lungs had acute graft dysfunction. After a long recovery period, Nazanin became stable and was able to walk again.

Road to recovery

Speaking on the surgery, Dr K R Balakrishnan said, “Ms Nazanin had pulmonary hypertension with her lung condition rapidly deteriorating and a transplant was the only option. Though the complicated surgery and continuous monitoring leading to recovery was a major hurdle, the Fortis Malar team was very confident throughout the entire process. To maintain any patient on ECMO for a month but post lung transplant with the risk of infection in an immune suppressed patient is a huge challenge. In complicated transplant surgeries like this, modern technology allows us to get excellent results but the treatment is expensive and complications cannot always be predicted. Funding mechanisms need to evolve in our country for such procedures to become universally available.”

Commenting on the surgical procedure, Dr Suresh Rao KG said, “We had successfully overcome several risks and challenges with effective monitoring and postoperative care. Ms Naznin was on ECMO for a month post bilateral lung transplant and on mechanical ventilation for almost 2 months. After a long stint of being on IV medications and antibiotics, she was mobilized out of ICU with a very good progress in recovery.”

“The doctors at Fortis Malar were very supportive and they gave me confidence and took care of me like their own family member. I would like to thank the doctors and all the staff and especially the nurses who were assigned to me full time in every shift,” expressed Ms Nazanin.

Image source: Fortis Malar Hospital

Published: August 17, 2018 12:24 pm

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