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PHOENIX – A man from Phoenix is the first in Arizona to survive COVID-19 using a rare form of therapy called extracorporeal membrane oxygenation therapy (ECMO).
Enes Dedic, 53, was on the verge of death with a ventilator until his HonorHealth doctors used ECMO as a last resort. Dedic is among the first American patients with COVID-19 to have survived the disease using the treatment and is one of more than ten patients worldwide.
ECMO works by helping to oxygenate the blood outside the body so that the blood does not need to pass through damaged or filled lungs. Instead, the tubes carry blood from the body to an external artificial lung, which removes carbon dioxide and adds oxygen, at which point an artificial heart pumps blood through the body.
It is a treatment of last hope, as the death rate on ECMO is around 40% – “extraordinarily high for almost all medical procedures” – according to doctors at Dedic.
After 10 days in a medical coma on ECMO, Dedic woke up reactive and was able to quickly face his wife.
“I can’t even speak,” said his wife, Olivera Dedic. “I was jumping from the roof when I heard they woke him up and he was fine. “
A doctor used therapy as a last resort: “ECMO or death for him”
After returning from a trip abroad, Enes Dedic spent a few weeks at home in the Deer Valley area of Phoenix, struggling with fevers, chills, body aches and nausea.
He first went to HonorHealth’s Deer Valley Medical Center on March 15 and quickly deteriorated. He was intubated and transferred to HonorHealth John C. Lincoln Medical Center in Phoenix for better mechanical ventilation.
A team of doctors tried everything to save him, said pulmonologist and intensive care doctor Dr. Anselmo Garcia. Enes Dedic has been treated with all of the potential drugs used for COVID-19, including hydrochloroquine, azithromycin, Kaletra, Actemra, antibiotics and anti-inflammatories.
None of this worked.
As a last resort, doctors turned to ECMO, said Dr. Robert Riley, chief of cardiothoracic surgery at HonorHealth. Riley performed the surgical procedure for ECMO.
“At that time, it was either ECMO or death for him,” said Dr. Ace Ovil, a surgeon specializing in trauma and clinical care. “Even though ECMO is a risky procedure and has potential risks associated with it, we thought we should give it a chance to fight to survive its disease. “
The procedure allowed Enes Dedic’s lungs to rest while the machine worked for them.
Riley said he was not sure it would work. At the start of COVID-19, early evidence suggested that ECMO was not a useful treatment and that its complications outweighed the potential benefits. But given the plight of this patient, the benefits were worth the risks, said Riley.
“From the bottom of my heart, I thought he was a strong man, he will survive,” said Olivera Dedic. “But at the same time, I was scared with all this technology, everything, the machines, the ventilators and everything they had to do for him, all these drugs. I was very, very afraid of what was going to happen. “
Enes Dedic was assessed daily for oxygen levels, x-rays, laboratory values and organ damage. He’s improved steadily every day, said Garcia.
After 10 days in a coma while on ECMO, the doctors woke him up and he quickly responded.
“It was a full team effort,” said Garcia. “There are 24 hour nurses, respiratory doctors, helpers, even housekeeping, just to make sure everything goes just right so that we can maintain the therapy that is needed for a patient on a daily basis.”
In recent days, he feels “much better” but is still “very weak,” said Olivera Dedic. He does physiotherapy and works to stand next to his bed. He is still in hospital and she does not know when he will be released.
Olivera Dedic has not seen her husband in person for a month. While in a coma, she could not sleep, often cried and tried to remember their happy moments together. She estimated “50/50” that he would survive ECMO treatment.
“It was very moving and scary,” she said. “I am very grateful to the doctors and nurses and all the hospital staff who saved my husband, and today I am still the wife of Enes Dedic. “
Will ECMO be used more widely to treat coronaviruses?
ECMO has been used for years for patients with H1N1, flu and lung damage, said Ovil. But it is a resource and labor intensive treatment and also a scarce resource.
For about 50 to 100 fans, there is only one ECMO machine available, said Riley. HonorHealth has five in its system. If treatment continues to pay off for other critical COVID-19 patients, there may not be enough devices to assist all patients in need.
Most patients with COVID-19 can be managed with a ventilator, but a subset of them fall so ill that a ventilator no longer helps. ECMO could be very helpful for this type of patient, said Ovil.
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Last week, the Food and Drug Administration released guidelines to expand the availability of ECMO devices to help fight COVID-19.
Garcia said the team was contacted by medical centers across the country for advice. Riley hopes their example of a “plug and play approach to care” will lead to more COVID-19 survivors.
“The proof of concept is quite important,” said Riley. “At first we were discouraged from trying even that, and people were dying. Now that we have had some success, we have learned a lot about how patients respond to this initial patient, and we are using it to help treat our later patients. “
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