In what is believed to be the first such procedure in the world, thoracic surgeons at Toronto General Hospital removed severely infected lungs from a dying mom, keeping her alive without lungs for six days, so that she could recover enough to receive a life-saving lung transplant.
“This was bold and very challenging but Melissa was dying before our eyes.” recalls Dr. Shaf Keshavjee, Surgeon-in-Chief, Sprott Department of Surgery at UHN, Director of the Toronto Lung Transplant Program and Director, Latner Thoracic Surgery Research Laboratories. “We had to make a decision because Melissa was going to die that night. Melissa gave us the courage to go ahead,
Melissa Benoit, then 32, was brought into Toronto General Hospital’s Medical Surgical Intensive Care Unit (MSICU) in early April 2016, sedated and on a ventilator to help her laboured breathing. For the past three years, Melissa, who has cystic fibrosis, had been prescribed antibiotics to fight off increasingly frequent chest infections.
A recent bout of influenza just before her hospital admission had left Melissa gasping for air, with coughing fits so harsh that she fractured her ribs. Her inflamed lungs began to fill with blood, pus and mucous, decreasing the amount of air entering her lungs, similar to a person drowning.
Dr. Marcelo Cypel, the thoracic surgeon on call that late April weekend, kept a careful watch on Melissa. On a Sunday afternoon, with the clock ticking, he kept weighing her risk of death versus the risk of trying something which had never been done before.
It was bold, but scientifically sound. Removing both her lungs – the source of bacterial infection – could save her life. (Watch Melissa Benoit, believed to be the world’s first person to survive without lungs for six days, share how she felt about the procedure.)
Dr. Cypel gathered his colleagues, calling in Dr. Shaf Keshavjee, Dr. Tom Waddell, Head of Thoracic Surgery at UHN, Dr. Niall Ferguson, Head of Critical Care Medicine at UHN and respirologist Dr. Mathew Binnie – all seasoned and well-known for their skills in navigating complex cases. Melissa’s husband, mom and dad also gave their assent.
The surgical team had been discussing the concept of this procedure for several years. They had observed patients with cystic fibrosis, waiting for a lung transplant, who developed severe lung infections. These infections spread through the bloodstream into their bodies, resulting in septic shock and death, despite maximum support on an external lung device.
While the team faced many unknowns – risk of bleeding into an empty chest cavity, whether her blood pressure and oxygen levels could be supported afterwards, and if she would even survive the operation – they agreed that Melissa was a possible candidate, and that it was her only chance, although a slim one.
At 9:00 pm that Sunday evening in mid-April, a team of 13 operating room staff, including three thoracic surgeons – Drs. Cypel, Keshavjee and Waddell – removed Melissa’s lungs, one at a time, in a nine-hour procedure. Her lungs had become so engorged with mucous and pus that they were as hard as footballs, recalls Dr. Keshavjee. “Technically, it was difficult to get them out of her chest.”
But within hours of removing her lungs, Melissa improved dramatically. She did not need blood pressure medication, and most of her organs began to improve.
To keep Melissa alive, she was placed on the most sophisticated support possible for her heart and lungs. Two external life support circuits were connected to her heart via tubes placed through her chest. (Generous philanthropic donors enabled UHN to acquire the state-of-the-art life support technology that helped make Melissa’s life-saving procedure possible.)
Six days later, a pair of donor lungs became available and Melissa was stable enough to receive a lung transplant in late April 2016.
“The transplant procedure was not complicated because half of it was done already,” noted Dr. Cypel, “Her new lungs functioned beautifully and inflated easily. Perfect.”
For the past several months, Melissa has been steadily improving. Her previously thick hair is growing back, she can play with her daughter for whole days without getting tired, and she has not needed a walker or cane for the past month. She is still on kidney dialysis.
“It’s the simple things I missed the most,” she said, “I want to be there for Chris (husband) and Olivia (daughter), even through her temper tantrums! I want to hear Olivia’s voice, play with her and read her stories.”