In a race to save a woman’s life, doctors in Toronto General Hospital resorted to a radical solution that has never been performed before – they removed her lungs for nearly a week, while she awaited a double-lung transplant.

“What helped us is the fact that we knew it was a matter of hours before she would die,” said Dr Shaf Keshavjee, one of three thoracic surgeons who performed the operation.

“That gave us the courage to say, if we’re ever going to save this woman, we’re going to do it now.”

Severe lung infection led to respiratory failure

Last April, 32-year-old Melissa Benoit, who was born with cystic fibrosis, arrived at the hospital with a severe lung infection that had aggravated from a recent bout with influenza.

The antibiotic-resistant infection led to septicaemia, and Benoit was quickly slipping into respiratory failure – her inflamed lungs were congested with blood, pus and mucus. Left with no choice, doctors kept her sedated in the Intensive Care Unit (ICU) and put her on a ventilator for respiratory support, but her organs began shutting down from septic shock and her condition continued to deteriorate, leaving her with only hours to live.

“She got into a spiral from which her lungs were not going to recover,” said Dr Niall Ferguson, head of the University Health Network, which is responsible for the Toronto general hospital. “Her only hope of recovery was a lung transplant.”

Doctors saved her life by removing lungs

The team of specialists gathered to discuss an unprecedented approach that experts have long contemplated, but have never performed, which was to eliminate the primary source of infection by removing both her lungs.

“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 Ferguson.

"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.”

Keshavjee, who is also the director of the lung transplant program, proposed the procedure to Benoit’s family, who consented without hesitation.

"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.”

Benoit lived six days with an empty thoracic cavity

The nine-hour long operation involved a 13-member surgical team who worked to extricate Benoit’s infected lungs, each swollen from severe inflammation and as hard as a football.

“It was difficult to get them out of her chest,” recounted Keshavjee.

Once the lungs were removed, Benoit was put on two machines: a small artificial lung which infused her blood with oxygen and removed carbon dioxide, and an extracorporeal membrane oxygenation which assisted her heart in circulating blood throughout her body.

“And literally within minutes – it was probably around 20 minutes after having taken those infected lungs out – her blood pressure normalised, and they could remove all the blood-pressure-supporting drugs and just leave her on the pumps that were providing the circulation,” Keshavjee said.

The procedure was a success, but doctors were unsure of how long Benoit could be kept on supportive devices.

“We didn’t know if we’d get (the donor lungs) in one day or one month,” said Keshavjee.

Fortunately, a suitable pair of donor lungs became available in six days, and Benoit underwent a successful lung transplant. She was gradually weaned off the ventilator after a month, and her health has steadily improved. Her muscles had atrophied from chronic hospitalisation, but with the assistance of physiotherapists, Benoit eventually relearned how to hold up her head, sit up and stand.

“It took me a while to realise what happened. I just couldn’t piece it together,” said Benoit, who is currently recuperating to undergo a kidney transplant from her mother, after the sepsis damaged her kidneys.

“You really come from the brink of death to back living at home. But I’m just so grateful, so happy to be home.” MIMS

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