Port Blair, September 26: In a commendable case of dedication and professionalism, a dedicated effort by the team of Doctors of MIOT Hospital and all supporting staffs has recently saved a poly-trauma patient, who was air-lifted from Port Blair even after the failure of the ventilator support.
Addressing a Press Conference at the Megapode Nest Resort yesterday, Dr.Prithvi Mohandas, Managing Director, MIOT, Dr.Vijit, Director Cardiotheiacic Surgery, Dr. Binoy, Director-International Cardiology. Dr.Nisheet TP, Director-Critical Care, MIOT Hospitals, informed the media that the patient suffered severe ARDS and multiple organ failure and was retrieved back to normalcy using the sophisticated ECMO procedure.
Addressing the Press Conference, Dr.Prithvi Mohandas-Managing Director said that giving the best healthcare to patients is the basic objective of the Hospital and not money.
Dr.Nisheet further informed that Mr. Vignesh aged 32 came up at MIOT only with her mother on February 17 in a severely injured state after suffering a road accident.
He said that Mr Vigneshwas recently married and has a kid of one and half year old. On February 13, around 10 in the night, Mr. Vignesh and his friend were returning home on his bike after a movie, they met with an accident because of a large drainage hole dug on the road and mud stacked all along the hole was not noticed by his friend, who was driving the bike.
The bike hit the piled mud and Mr. Vignesh, who was the pillion rider was thrown onto a concrete mixer machine.
He was badly injured and immediately was rushed to the GB Pant Hospital, where he underwent initial treatment for three days.
There, they had identified severe chest injury and collection of blood in both his lungs. Tubes had to be placed on both sides of the lungs to drain out blood. For further treatment he was referred to MIOT Hospitals, Chennai under AnishiScheme. He was airlifted along with a doctor from GB Pant, Port Blair to Chennai in a critical condition.
As soon as he arrived at MIOT, he was attended by the Critical Care Team. He was found to have difficulty in breathing and immediately needed ventilator for stabilization.
“In most of the cases, the patient is removed from ventilator by 3rd or 4th day once the condition stabilizes, which was not possible for Mr. Vignesh. The lungs were still in a very bad state. On day 4, tracheostomy (A hole in the wind pipe) was done for which he needed ventilator for a longer duration. There was no improvement seen even by the 8th or 9th day. So, CT Chest was done, which showed damaged lungs with persistent blood collection. The Cardio-Thoracic team was called who took him up for “Decortication”, a Lung surgery performed to clean and remove all the collected blood and help in lung expansion.
Even a week post lung surgery by Day 15, there was no improvement,” DrNishit said.
He further added that MrVignesh continued to require high ventilator support for breathing. Repeat imaging was done which still revealed badly damaged lungs with presence of blood. He was taken up for repeat lung surgery on Day 16. Even after all this efforts and surgeries, he was deteriorating. His oxygen levels in body were reducing and carbon-di-oxide levels were increasing. It was becoming difficult to sustain him on the ventilator. By day 18, on maximal ventilator support, blood pressure started falling and kidneys started shutting down. He had also picked up a bacterial infection in blood (Klebsiella) by this time. Over the next 12 hours there were dangerous levels of potassium and acidosis in his blood and it was getting tougher keeping him alive.
To stabilize kidney failure Continuous Renal Replacement Therapy (CRRT) was started. CRRT is a type of dialysis performed continuously that is used to treat critically ill, very unstable patients. Within the next 12 hours, acidosis and potassium levels were brought under control. By day 23 despite all these measures he crossed the maximal ventilator support possible and had progressed to multiple organs failure with dropping blood pressures and renal shutdown. This is when the doctors decided to take him to the next level of life support, the ECMO (Extra Corporeal Membrane Oxygenation).
ECMO is a treatment used, when our lungs fail completely. It is a device that pumps blood through an artificial lung and back into the body. Within 24 hours on ECMO, things started changing. Mr. Vignesh oxygen levels had become normal. Blood pressure started stabilizing and was tolerating dialysis much better. During the course of our ECMO we too had bleeding from multiple sites which were handled, however the worst episode was the lung bleed. It was the left lung bleed which had started pouring into the right lung. To protect the right lung from further damage the left lung had to be isolated. This bleeding had taken us back by few days in his lung recovery. Subsequently when bleeding stopped, the blood clots from the lungs were removed.
Mr. Vignesh kidneys continued to be supported with dialysis which by itself is a major challenge when on ECMO. He was not tolerating feeds and his nutrition had to be given through his veins. After 15 days on ECMO, with rest to lungs, his lungs had recovered reasonably well to remove from ECMO and step-down back to ventilator. By this time his blood pressures had stabilized and his kidneys had recovered to be off dialysis.
Day 40 in the ICU and two days after ECMO removal, he was found to have irregular heart rhythm. On evaluation with ECHO heart it was found that he had large fluid collected around his heart, known as pericardial effusion. He had to undergo emergency removal of about a litre of bloody fluid from around his heart in the Cath lab. The heart function had currently dipped to an extremely low level and his heart was hardly pumping. Medications were given to improve the heart function. The fluid taken from around the heart had evidence of bacterial infection.
After 49 days, Mr. Vignesh was completely freed from ventilator. He required a dedicated physiotherapy and rehabilitative team to work on his week hands and legs. After 60 days of ICU, he was shifted to ward. He was able to stand, walk and started taking normal food. He got discharged by the 65th day. 2 weeks later he came for a review. His Chest X-ray was totally clear and ECHO showed regained heart function. The past was history. He was back to his family and little daughter.
ECMO is reliable and important treatment in patients with failing lungs or failing heart. ECMO comes with unique challenges which require expertise, and a huge team effort & infrastructure to run successfully. So being at the right place at the right time becomes very crucial.
The patient’s mother said that she and her family will remain grateful to MIOT hospital and its staff for saving the life of her son.
“We haven’t deposited money first for the treatment of my son but even though the MIOT started treatment of my son immediately after he was admitted,” said S.Theanmoli the mother of the patient.
An amount of Rs 45 lakh was incurred on treatment and I was in dire need of Rs 20 lakh. The Member of Parliament and the Chief Secretary extended all possible support for the treatment.
