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Health & Fit Her Young Patient Got the First COVID-19 Double-Lung Transplant in the U.S.

01:35  09 july  2020
01:35  09 july  2020 Source:   usnews.com

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A young woman whose lungs were destroyed by the coronavirus received a double lung transplant last week at Northwestern Memorial Hospital in Chicago, the hospital reported on Thursday, the first known lung transplant in the United States for Covid - 19 . The 10-hour surgery was more difficult and

"If she didn't get the transplant , she would not be alive." The hospital said it believes this is the first time such an operation on a Covid - 19 patient has been performed successfully in the United States, and it offers new hope for patients with extensive lung damage from coronavirus infection.

In the COVID-19 intensive care unit at Northwestern Memorial Hospital in Chicago, every patient was extremely sick, but one woman in her 20s was in a class by herself.

The infection, along with the severe inflammation and scarring that so often accompany it, had literally destroyed her lungs. She'd been put on a ventilator almost immediately, but after a few days even that wasn't enough, and the ventilator was supplemented with an ECMO (extracorporeal membrane oxygenation) machine, essentially a mechanical lung. Machines handled all her breathing for more than a month. The dozens of clinicians on her care team had one gargantuan task: keep her alive until COVID-19 cleared her body and they could see if there was any chance for her lungs to recover their function.

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In a first , a young COVID - 19 patient in the U . S . has received a double - lung transplant after the Double - lung transplants — in which both lungs are replaced with healthy ones from donors who "How did a healthy woman in her 20 s get to this point? There' s still so much we have yet to learn

A young COVID - 19 patient in the U . S . has received a double - lung transplant after the coronavirus ravaged her lungs. The operation is believed to be the

By early June, it was obvious that her lungs were shot, and the patient was put on the waiting list for a double lung transplant. She received the life-saving surgery 48 hours later – becoming the first known patient to undergo such a procedure in the U.S. as a result of COVID-19.

The case highlights the danger of COVID-19 to people of all ages – not just to the elderly, who were initially the most visible victims.

"There were many days when she was the sickest person in the whole hospital," says Dr. Elizabeth Malsin, 35, the point person on the complex task of preparing the patient for her transplant after she finally tested negative for active COVID-19 infection.

Malsin, a pulmonary critical care physician, had been part of the team caring for the patient for weeks, checking for infection and carefully monitoring her other organs to make sure they were getting enough oxygen. She happened to be on duty in the medical intensive care unit when the patient was put on the transplant list.

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The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

Suddenly Malsin was in the "hot seat": responsible for coordinating the surgical transplant team and the infectious disease specialist; checking that the patient's tissue-matching information was up to date; arranging for all tests and checking the results. The team had to keep the patient stable at all costs – including reinflating a lung that had collapsed, making her respiratory status even more fragile than it was already.

The hardest part for Malsin was knowing her patient only as a mass of IV lines and medical equipment. "We had met briefly before she was placed on the vent, but I didn't have any in-person sense of who she was," Malsin says. "People just look so different when they're that sick." She did get to know the patient’s family through daily FaceTime calls, and they provided a photo of the patient with her nephew, an image that Malsin found invaluable. "That was the goal: We needed to get her back looking like that picture," Malsin says. "This is who she is."

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The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

Malsin has had plenty of chances to hone her expertise in caring for patients with very sick lungs since completing a fellowship at Northwestern last July in pulmonary and critical care medicine. She has been an attending physician in Northwestern's medical ICU ever since, and she switched to the COVID-19 ICU full time when the pandemic hit Chicago in March.

Malsin grew up in Oshkosh, Wisconsin, and took the Northwestern fellowship partly to be closer to her family. She was always interested in science, and did original research on autoimmune diseases, especially lupus and rheumatoid arthritis, as a biology major at the University of Minnesota. The scientist running her lab was also a physician and encouraged her to study medicine so that she could see "how science was put to work in real time." After medical school at Drexel University in Philadelphia, she spent her internal medicine residency at the Hospital of the University of Pennsylvania. There, she became fascinated by critical care, which requires clinicians to understand how all the organs and systems of the body interact and respond during a crisis.

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The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

The woman’ s lungs were irreversibly damaged by COVID - 19 , and she had been on a ventilator for six weeks. A team at Chicago’ s Northwestern Memorial Hospital recently performed a double lung transplant on a woman in her 20 s . The woman’ s lungs were irreversibly damaged by COVID - 19 , and

"I love helping really, really sick people," she says. "It's primary care on steroids." Malsin will delve further into complex lung problems this year with a new fellowship at Northwestern specifically in interventional pulmonology. It's a relatively new field that uses a bronchoscope – a device for looking inside the lungs – and other tools to treat certain lung conditions without surgery.

Malsin's main research focus has been chronic lung disease, but her experience treating COVID-19 has piqued her interest in studying pneumonia. She is particularly intrigued by COVID's most pressing question: Why some people get so sick while others do not. Malsin and her colleagues have been studying "inflammatory markers" – substances in the blood that are signs of the body's response to infections – in the lab results of patients with COVID-19; they’ve noticed that levels of some of those markers seem to predict who's going to get sicker and who's going to start healing soon. "We don't know all the specifics yet, but there are certainly patterns to help us on the path."

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Malsin lives on Chicago's North Side with her husband, who works in technical marketing and has been doing his job from home as well as cooking Malsin delicious meals – her favorites include pan-seared sous vide steak and smoked jalapeño poppers – during her precious time off from the ICU. She unwinds through exercise, especially pedaling on her Peloton stationary bike, reading fiction, and hanging out with Tonic, their 30-pound pit bull/Jack Russell Terrier mix, who may be the only member of the household completely enthusiastic about the current status quo.

At this writing, Malsin's lung transplant patient is close to graduating from the surgical ICU; she's breathing on her own and starting to eat and swallow normally. She'll work with physical and occupational therapists to relearn even simple things like brushing her teeth.

"It's a marathon," Malsin says. "Our hardest work is done and now it's going to be a lot of hard work for her, but she's very motivated." When Malsin is on COVID duty, she can't just pop into the surgical ICU to see how her patient is doing because of the danger of spreading infection, but she keeps tabs from afar. Her most fervent wish is for her patient's COVID journey to be over – so she can go home. "I hope I never care for her again," Malsin says.

Though the pandemic in Chicago has currently leveled off to the point where Northwestern's five COVID ICU teams have been reduced to one, there are several other patients waiting for their infections to clear so that they can be added to the lung transplant list. Malsin observes that the youth of the first patient is not an anomaly. "I wish it were true that we were only seeing older people, but unfortunately we have seen people just as young, or even younger, get very, very sick."

Malsin's message to the public is twofold. "This is real," she says. "Take masking seriously. Stay home when you're sick, and take care of yourself when you have symptoms."

But equally important, don't despair. "You hear the bad news that no one is surviving (once they're in the ICU) but it's not true," Malsin says. "Some are sick for weeks, but there is a lot we can do to support you if you get infected. There are new things coming out all the time. We are here, and we are not losing hope."

Copyright 2020 U.S. News & World Report

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