Chen Jingyu is the vice president of Wuxi Peoples Hospital, known as the first person in China for lung transplantation. At ordinary times, he often travels with his team members to and fro Wuxi and Beijing, and needs about 250 lung transplants a year.
After the outbreak of the new crown, many hospitals across the country stopped unnecessary operations in order to prevent hospital infection and support the front line in fighting the epidemic. The same is true of the thoracic surgery department of Wuxi Peoples Hospital, where Chen Jingyu is located. Many medical staff were sent to support Wuhan.
However, the high mortality rate of critical patients and the death cases of some young patients also attracted Chens attention. They found that even with ventilator or ECMO support, nucleic acid tests were negative and some patients died.
Chens team analyzed that this may be due to the impact of the virus, the patient has irreversible damage, resulting in respiratory failure. Because our team is engaged in lung transplantation, we have been thinking about whether we can take lung transplantation to save them.
A novel coronavirus pneumonia in Wuxi Infectious Disease Hospital, after continuous intubation, ECMO and medication, has been negative for continuous nucleic acid detection, but the function of both lungs is also severely damaged and irreversible.
On February 28, the patient suffered from massive pulmonary hemorrhage and could die at any time if not treated in time. In this case, Chens team decided to perform an emergency lung transplant for him. A charity donation team for brain death in Henan Province collected a donor from a brain dead patient and transported the donor to Wuxi via high-speed rail Monday.
The donor was sent to the operating room of Wuxi infectious diseases hospital at 7:00 p.m. Five hours later, the operation ended successfully. Chen Jingyu said he hoped novel coronavirus pneumonia patients would be brought to the country through the experience of this kind of operation.
The following is an interview with Chen Jingyu by Nandu:
The novel coronavirus pneumonia case requires three medical prerequisites for lung transplantation.
Nandu: what time did novel coronavirus pneumonia start to be considered as a lung transplant?
Chen Jingyu: since novel coronavirus pneumonia was closed in Wuhan in January, I have been thinking about this problem for more than a month now. Can I have a lung transplant for the advanced patients with new crown pneumonia? Especially in the case of high mortality, we found that many patients in good physical condition quickly worsen to death.
No one knows whether novel coronavirus pneumonia can be transplanted into the lung. No one can answer this question. The virus may invade more target organs, and the heart, liver, kidney and lung may be affected. So it is worth studying.
Nandu: have you ever operated on patients with infectious diseases before? What can we learn from this?
Chen Jingyu: in clinical practice, we have operated on patients who are hepatitis B positive and HIV positive, but doctors need to do extra protection.
We have also done novel coronavirus pneumonia, some of which are caused by viral infection. For example, we have successfully performed lung transplantation for pneumonia, pulmonary fibrosis and pulmonary consolidation caused by H1N1 or adenovirus infection. One patient was infected with the virus before the operation. After 45 days of life support by ECMO, we successfully performed lung transplantation.
So we have novel coronavirus pneumonia patients who have surgery to do the surgery, but now we have a very infectious virus. Our team is willing to fight for the patients chance to survive.
Chen Jingyu: novel coronavirus pneumonia is the most important medical condition for lung transplantation. There are three medical prerequisites. The first is that the patient is maintained by ventilator + ECMO, and the respiratory failure of both lungs is irreversible; the second is that the nucleic acid test is negative for many times in a row; the third is that the function of other organs is basically normal, and the general condition can withstand lung transplantation.
In this lung transplant, there was massive hemorrhage in No. 28 lung, and the whole lung was congested with high tension. It was on the verge of hemorrhagic shock and almost left. In this case, after discussion with the provincial experts, we started the operation in an emergency, and there were donors.
Nandu: what was the lung condition of the patient at that time? What checks did the operation do before?
Chen Jingyu: before the operation, we gave him a detailed examination. Because novel coronavirus pneumonia affects the patient, the lung appears fibrosis, also has diffuse cell necrosis. Before the operation, we tested the nucleic acid of the nasopharynx swab, blood and lung lavage fluid, and only started the operation after they were all negative.
Wear 3-layer and 4-layer isolation protective devices, and the operation medical students and nurses cannot communicate
Nandu: compared with peacetime, what are the tests of this operation on the team?
Chen Jingyu: this new crown lung transplant is also a psychological and physical test for our team. In order to operate on patients with infectious diseases, first of all, negative pressure operating room is needed, and medical staff should wear 3 or 4 layers of isolation protective devices to protect them.
When we wear headgear to do surgery, sweating will paste the mask off, so that we cant complete the operation. For this reason, we have a small motor that can supply air to the protective clothing, so that we can see it clearly. At the same time, three layers of gloves should be worn during the operation, which will increase the operation load. Although we operate under the condition of negative pressure operating room and multi-layer protection, the risk of infection cannot be excluded.
When you wear such a thick protective device into the negative pressure operating room, its all buzzing. Basically, doctors and doctors, doctors and nurses cant speak, hear clearly or make eye contact.
Its also difficult to avoid bleeding in lung transplantation, but if this patient has another thoracotomy to stop bleeding, he may not come back, which is also a test for us. To do such a difficult operation, we can imagine that the requirements will be very high. The team must have a good understanding to make the operation perfect.
Nandu: how to achieve this tacit understanding?
Chen Jingyu: our team has done more than 1000 lung transplantation operations. The cooperation between doctors and nurses is very good. Basically, I make body movements, such as I need vascular forceps, sutures, and so on. They know what I need.
In order to complete the operation without speaking, we also organized a medical team exercise before the actual operation. After everyones running in, the operation was basically a perfect cooperation. This operation is almost the same time as usual. The operation is relatively smooth.
After the operation well sober the patient up. I would like to withdraw ECMO this evening, but we should be careful. We should consider withdrawing ECMO tomorrow, and next we should consider withdrawing ventilator.
We hope to bring novel coronavirus pneumonia to all the patients in China through lung transplantation.
Nandu: novel coronavirus pneumonia patients undergoing this operation?
Chen Jingyu: the novel coronavirus pneumonia is completely different from the normal lung transplant. Because the virus has hit the patients immune system a lot and the patients immune system has collapsed, we think the rejection reaction will be very small. These factors will be taken into account in drug use.
From the specimens taken after operation, the patients left lung is fibrotic and has collapsible consolidation; the right upper lobe and middle lobe of the lung are the same fibrotic consolidation as the left lung, but the lower lobe of the right lung is very swollen due to massive hemorrhage. We think its necrosis. Because of lung inflammation, the whole bronchus, alveoli and mucosa are congested and edematous, which is prone to necrosis.
Nandu: what novel coronavirus pneumonia can help the new crown?
Chen Jingyu: the diseased lung was sent to P3 Laboratory of Jiangsu CDC for anatomy and basic research. This is different from the autopsy specimen, because we take the diseased lung directly from the recipient. The specimen is fresher and more valuable for research. We hope to further novel coronavirus pneumonia by pathological analysis and save more patients.
For our team, novel coronavirus pneumonia transplantation is a new topic. We would like to summarize the experience learned from this patient in time, improve the operation process and the drug treatment plan after the operation. In this way, when we do the next operation, we will have more courage, be more prepared and thoughtful.
Medicine is always in constant exploration, and there are always some medical staff willing to make contributions to it. Hope to lay a good foundation for other teams in the country to promote lung transplantation. We hope that novel coronavirus pneumonia will be brought to the nation through such operations.
(the picture in the article is provided by the interviewee)