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04 Apr 2018

San Team use ECMO in life-saving incident

Even after 10 years of hundreds of often difficult and life-changing heart surgeries, as she tells the story, you can tell cardiothoracic surgeon Dr Emily Granger is incredibly thankful.

“I was determined that we were going to give him every chance we could” she says a few weeks after a dramatic incident in which a patient suffered an unforeseeable and rare allergic reaction to a transfusion during heart surgery.

“When I first met him before the surgery I was struck by what a feisty independent man Peter was – he was so determined to get through his desperately needed bypass surgery and get home.

While less than 1 in 10,000 transfusions result in the complication, Peter was one of the unlucky ones whose body reacted to what is a standard part of his surgery, with a transfusion related acute lung injury (TRALI).

At 84 years of age, it was life-threatening … he really only had a few minutes left."

Peter’s body was rejecting the blood transfusion leading to fluid build-up in his lungs. Commonly, TRALI causes fever, chills, tachycardia, hypotension and respiratory failure.

“I was determined to give him every opportunity to try and pull through the first 24 hours of his adverse reaction, I just couldn’t let him die.” Dr Granger says.

“I knew getting the ECMO into theatre would give him a fighting chance and the team could help do the rest.”

The San’s ExtraCorporeal Membrane Oxygenation machine (ECMO) acts as a temporary lung and also supports the function of the heart. The San is one of the few private hospitals in NSW that has an ECMO onsite. The ECMO is connected to the patient via an artery or vein through the groin and can also be used in the case of a heart attack, severe pneumonia or allergic reactions, when other options are limited.

“It was because the San has an ECMO circuit, and that an experienced team was on standby, that we were able to save Peter’s life.

What made it all the more special for the team involved this time was that some of them remembered him from his original successful bypass surgery close to a decade ago and they were determined to make it another good outcome for him.

Dr Brad Smith was the anaesthetist involved during the surgery who identified the adverse reaction while medical perfusionist Dr Pietro Fiorentino and perfusion technician Sally McLeod cared for him continuously over several days, even working through and foregoing their planned overnight birthday celebrations, staying with Peter until he got through the worst of it.

I’m really thankful we had the right equipment and the right team in place at the right time to produce the best outcome. Seeing him the next day on the road to recovery …well, it might have been his heart that we fixed …but everyone else’s heart was feeling pretty good too.”

The surgery occurred at the San on the 14th March.

Photo above: Dr Melissa Doohan, Dr Emily Granger and Sally McLeod with Peter after his successful bypass surgery.

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