Toronto doctors remove dying woman's diseased lungs to buy time for transplant
Sheryl Ubelacker, The Canadian Press
Published Wednesday, January 25, 2017 5:02AM EST
TORONTO -- In what's believed to be a world first, Canadian doctors say they were able to save a young mother's life with a radical procedure -- they removed her lungs.
Melissa Benoit, who was born with cystic fibrosis and had developed a rampaging lung infection that had spread throughout her body, was hours away from death last April when doctors at Toronto General Hospital were given the go-ahead by her family to take the unprecedented step.
Benoit, then 32, spent the next six days in the ICU without lungs, kept alive by state-of-the-art technology that oxygenated and circulated her blood until donor organs came available and she was able to have a life-saving transplant.
On a ventilator and in an induced coma, the Burlington, Ont., mother of a three-year-old daughter had been unaware of how close she had come to dying or what doctors had done to save her life.
"I didn't believe it," she said, recalling what her husband, Chris, and her parents told her after she regained consciousness. "It took me a while to realize what happened. I just couldn't piece it together."
Still, that initial decision to remove her lungs -- the source of an antibiotic-resistant infection that had tipped her into widespread organ failure and septic shock -- wasn't taken lightly.
"It was a difficult discussion because when we're talking about something that had never to our knowledge been done before, there were a lot of unknowns," said Dr. Niall Ferguson, head of critical care at the University Health Network, which includes Toronto General.
Benoit had been transferred to TGH in early April 2016 from St. Michael's Hospital, where she had been admitted after a bout of influenza had left her gasping for air, with coughing fits so racking, they fractured some of her ribs. Her inflamed lungs began to fill with blood, pus and mucous, leaving her feeling as if she were drowning.
None of the antibiotics doctors tried were able to kill bacteria that had invaded her CF-damaged lungs and blown up into a super-infection, and despite being on a ventilator, her condition continued to deteriorate.
Ferguson, who had been overseeing Benoit's care in the ICU, said her blood pressure had plunged and her oxygen levels were critically low, so he and a team of thoracic surgeons discussed the possibility of buying her some time by removing her lungs to stop the rampant infection that was infiltrating her body.
"In Melissa's case, our hand was being forced a little bit because she was actively dying, and if we hadn't done something, she would have died that day for sure."
Dr. Shaf Keshavjee, director of the lung transplant program, said the team weighed the pros and cons and presented the idea of the last-ditch procedure to her family -- and they immediately agreed.
"She had made it very clear that she wants to live for her family, for her child, and to do anything -- experimental or not -- to give her a chance if we could do it," said Keshavjee, one of three thoracic surgeons among a 13-member surgical team who took part in the nine-hour operation to extricate Benoit's severely diseased lungs.
The surgeon described each lung as being so heavy and rock-like, "we could barely pry it out of her chest."
Benoit was put on two machines: a Novalung, which infused her blood with oxygen while removing carbon dioxide -- as the lungs do naturally -- and extracorporeal membrane oxygenation, or ECMO, that helped her heart pump the blood through her body.
"And literally within minutes -- it was probably around 20 minutes after having taken those infected lungs out -- her blood pressure normalized and they could remove all the blood pressure-supporting drugs and just leave her on the pumps that were providing the circulation," Keshavjee said.
"It proved the concept is successful, but how long could you support her in this condition?" he said, adding that the biggest uncertainly was how long it would take for replacement lungs to become available.
"We didn't know if we'd get (them) in one day or one month ... So it was a day-to-day thing, and thankfully in about five to six days, we did get donor lungs offered that were her correct blood type and a reasonable size match, so we could go ahead with the transplant."
The team's report on the case is published in Wednesday's issue of the Journal of Thoracic and Cardiovascular Surgery.
When Benoit finally came to after the transplant, her muscles were so deconditioned from having spent more than three months in hospital before the back-to-back operations, she couldn't even lift her hand to let her family know she was conscious.
"The only thing I could do was stick out my tongue," she said, and then only with the encouragement of her mother.
"That was the only way I could get her to communicate with me," recalled Sue Dupuis. "I said: 'Please Melissa, if you can hear us, stick out your tongue.' And it took a good 20 minutes for that tongue to come out just a little bit ... You know, it's like a movie."
It wasn't until Benoit was eventually weaned off the ventilator about a month later that she realized what it meant to have new lungs, which are unaffected by the mutated gene that causes CF.
"That was when I was, wow, I could breathe. I never had this feeling. I didn't cough anymore. When you have CF, you cough all the time," she said, dabbing away tears.
But that was only the beginning of a long road back to health. With the help of physiotherapists, Benoit had to learn how to hold up her head up again, to sit up and then to stand.
"I never thought I'd do it again. I never thought I would walk. And here I am walking," she said, hugging her daughter Olivia.
"You really come from the brink of death to back living at home. But I'm just so grateful, so happy to be home," said Benoit, who had to go on dialysis after her kidneys failed as a result of the sepsis. She hopes to be well enough for a transplant in the next few months, with her mother donating one of her kidneys.