David Lopes, of Gettysburg, was believed to be the first confirmed COVID-19 patient at Wellspan York Hospital when he showed up with severe symptoms March 18.
He required a ventilator almost immediately, which wasn’t a good sign. Statistics show 80 percent of virus patients who go on the ventilator don’t survive.
Nine days into his hospitalization, Lopes, 56, ripped out his ventilator while sedated, putting his recovery in even more jeopardy. His doctors re-intubated him but believed he was facing imminent death.
That’s when doctors decided to try a rare treatment approved just this month in the United States for use on COVID-19 patients: an ECMO machine. Extracorporeal membrane oxygenation has been around since the 1970s, but it has only been used about 540 times across the world during this pandemic. It is considered “a last-ditch effort” to save a patient’s life by acting as an artificial lung,
Tubes from the machine were attached to ports on Lopes’ jugular and femoral arteries to add oxygen to his blood and remove carbon dioxide. The device would give his terribly inflamed lungs a chance to rest.
At first, Lopes’ condition worsened, said Dr. Dmitriy Zubkus, whose team made the decision to put Lopes on ECMO. But after a few days, Lopes started getting better.
In all, he spent eight days on ECMO before he was weaned off the device, his ventilator and his feeding tube. He eventually passed his swallow test to ensure he could safely eat without inadvertently inhaling something into his still-fragile lungs.
On April 18, a month after a helicopter flew him into Wellspan York Hospital, he walked out and went home.
“He didn’t just survive,” Zubkus said. “He walked out of the hospital.”
Only about 50 patients who have been put on ECMO for the novel coronavirus around the world have been discharged alive from a hospital, according to a website that tracks ECMO use.
The treatment doesn’t always work, but when it does, “it’s magnificent,” Zubkus said.
David Lopes worked as a forklift operator and doesn’t know how he picked up the virus. But he first noticed symptoms on March 10 when he and his wife were out for their weekly date night for wings.
“Let’s go home,” David said to his wife. “I really don’t feel good.”
A customer had recently been diagnosed with the flu, so David Lopes assumed he caught that. He called his primary care doctor and arranged for a flu test, but it came back negative.
Lopes started feeling a bit better, so he didn’t worry about it— until March 14, when fever, cough and shortness of breath hit him like a ton of bricks.
The Lopes went to a walk-in clinic in Gettysburg where workers immediately told the couple to go to the Wellspan Gettysburg Hospital emergency room
The hospital tested David Lopes for various ailments, but not COVID-19, and sent him home with some general medications.
Three days later, his condition had significantly worsened, so Colleen brought David back to the hospital, where he tested positive for COVID-19 and they admitted him. Colleen didn’t know it then, but it would be the last time she would see her husband for 31 days. Visitors are not allowed in hospital rooms to avoid spreading the disease.
A distraught Colleen consulted a friend who advised she should transfer David to Wellspan York Hospital, where they have a dedicated pulmonary unit, and Colleen made the request.
David didn’t think he was strong enough to make the trip. Doctors were preparing to intubate him and put him on a ventilator.
“I couldn’t get any air into my lungs,” he said. “It felt like I couldn’t get any air.”
A helicopter flew David to Wellspan York Hospital, because he probably wouldn’t have survived a road trip.
At Wellspan York Hospital, David was heavily sedated and said he has no memories of his early days there. He remained on the ventilator, but apparently woke up enough at one point to break out of his restraints and rip his ventilator out.
It really set him back, doctors said. He aspirated something into his lungs, causing pneumonia.
That’s when the hospital’s chaplain and social workers started calling Colleen to prepare for the possibility of David’s death if his organs started to fail. Colleen arranged for a priest to visit David’s room in full protective gear to perform an anointing of the sick.
As it turned out, that wouldn’t be necessary.
Doctors made the decision to try ECMO on him, believing he was a good candidate. David had a pulmonary embolism four years ago and suffered from asthma but otherwise didn’t have any known underlying conditions. Zubkus said he doesn’t not believe Lopes would have survived another day without it.
One thing doctors have learned about using ECMO with COVID-19 patients, is to not wait too long.
Doctors in Bejing used ECMO about five times, but didn’t have good results, Zubkus said, so it was initially thought that the treatment wouldn’t be helpful for the virus.
But doctors in France used it about 150 times, and started using it earlier in a patient’s decline. So instead of monitoring a patient’s downward trajectory, and trying different therapies such as temporarily paralyzing patients and then turning them on their bellies, which are steps that can improve oxygen flow, doctors shifted more quickly to ECMO on patients.
“France taught us that earlier is better. So we pull the trigger earlier,” Zubkus said. “If things don’t work for a patient, we don’t need to wait 24 hours to see what’s going to happen because we know where this is going to go.”
ECMO is incredibly invasive, which can increase complications like bleeding and infection, and it’s used on critically-ill patients, so finding great outcomes can be difficult. But David turned out to be a shining success story.
“A lot of people may survive after ECMO, but how? In a nursing home, or still on a ventilator?” Zubkus said. “They are alive, but can they really function? He did amazingly well.”
After David first came out of his induced-coma, he didn’t know where he was. When nurses told him he was hospitalized, he didn’t remember why. He thought the year was 1994.
Being alone in the room without any loved ones was incredibly difficult, David said.
He wasn’t the only one suffering.
Colleen and their adult daughter Marilyn both came down with COVID-19 symptoms during David’s hospital stay with Marilyn saying it was the sickest she had ever felt in her life.
“I was worried my daughter would have to be hospitalized too,” Colleen said. “It was a complete nightmare.”
Quarantined at home, Colleen staged video conferences every night with 16 people for prayer sessions. She called the hospital four times a day for updates.
“It was the most overwhelming endurance test I’ve ever taken,” she said. “It was very stressful. The worst part was thinking about what life would be like without him.”
But on April 18, David Lopes walked out of the hospital. He was on oxygen and using a walker, but he still walked out.
“We were all crying,” Colleen said. “The doctors and nurses were crying too. Nobody expected him to be leaving like that.”
David’s lingering complications are minimal. He has bouts of vertigo, some short-term memory loss, and numbness in his thighs. He is still weak from being sedated and bed-ridden for weeks in the hospital, but otherwise is doing well.
Lopes needs rehabilitative therapy, but initially could not be accepted into a facility until he tests negative twice for COVID-19. He received his second negative test result Friday.
That means the Lopes can now take off their masks and gloves inside their home. Previously, they had to keep the protective gear on just in case.
David was among the first patients in Pennsylvania to get the ECMO treatment for his COVID-19. In all, the therapy has only been used about 20 times in the state of Pennsylvania.
The machine isn’t a cure for COVID-19, but it allows a patient to survive the ravages of the virus long enough for the body to heal itself or for other treatments to work.
Besides Wellspan York Hospital, three other hospitals in the region have ECMO: UPMC Pinnacle in Harrisburg, Penn State Hershey and Lancaster General. So far, Wellspan York Hospital has used ECMO on two COVID-19 patients, and for six years prior on non-pandemic patients.
“We do 50 to 60 cases per year (for heart or lung patients,)” said Zubkus. “We have quite a bit of high-level experience with ECMO.”
Since Lopes’ case, several other patients have been transferred to York for consideration of ECMO, but less-invasive options were chosen and those patients survived without the intervention.
The machine requires nurses to check a patient’s blood levels every hour and also check the machine every hour, which is a “huge, huge, huge investment,” Zubkus said. “But when it pays off, it’s magnificent.”
Lopes’ recovery was so remarkable, Zubkus wrote an article that was accepted for publication in a medical journal so other doctors could gain insights from the case.
Meanwhile, David wants to donate his plasma to possibly help other COVID-19 patients recover. The liquid portion of blood taken from survivors of the disease contains antibodies that may boost a person’s ability to fight the disease.
Colleen, for her part, is incredibly grateful for the hard work of the medical team at Wellspan York Hospital.
“I want to give credit to the hospital,” Colleen Lopes said. “The care they gave him was exceptional. If not for that exceptional treatment, he would not have survived.”
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