The covid devastated the lungs of Jordi Soriano, 51 years old. They were black and almost fell apart between the fingers, recalls Alberto Jáuregui, head of the Thoracic Surgery and Lung Transplant Service at the Vall d'Hebron Hospital in Barcelona. The virus was extinguishing them, they stopped breathing and Soriano was placed on an extracorporeal oxygenation machine (ECMO, for its acronym in English) that cleaned his blood. In total, 127 days, about five months, tied to an intensive care bed with no signs of a comeback. “The lungs are like balloons, but Jordi's were two collapsed pieces of meat. They were very affected ”, sums up the doctor. The patient did not improve and the only way to escape was a transplant, the first to be done in Spain to a post-covid patient. "I said:
come on
.
I had no other option, ”Soriano recalls now.
With the trace of the tracheostomy still healing and a zipper from end to end of the chest in the process of healing, the man has returned to breathing alone.
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He does not know what happened on those days in late January when, presumably, he was infected. Perhaps it was in the hospital, he suspects, in one of the many visits he made to accompany his father-in-law, whom he used to take care of. “One day, I was cleaning my father-in-law and I passed out. I collapsed, ”says Soriano. The medical teams that came to his aid confirmed the diagnosis of covid and he was referred to the Bellvitge Hospital in Barcelona with a bilateral pneumonia caused by the virus. “He had no underlying pathologies. Just a pulmonary hypertension, as many people have. Nothing else, ”recalls Jáuregui. But all the treatments failed.
The inflammation in his lungs was such that he did not respond even to mechanical ventilation. A few days after admission, in fact, the Bellvitge doctors connected him to the ECMO machine, the last cartridge when the ventilator is not enough. This device, which cleans the blood and breathes for the patient, does not heal, but it buys time. Time for the lungs, which have a high recovery capacity, to go back. But in the case of Soriano, the days and months passed without any improvement, stuck in a massive inflammation without turning a leaf. So the Bellvitge doctors played their last card and requested an assessment for transplantation from the Vall d'Hebron committee, a benchmark in Catalonia for these interventions.
“In China, the first transplants were made to post-covid patients. We know that there is a time when the lungs do not work, they do not just recover. At the beginning of the pandemic, they were transplanted very quickly, but then it was found that over time, the lungs recovered on their own. But there are cases where they don't succeed, and we don't know why, ”says Jáuregui. There are not many, adds the doctor, and the profile responds to healthy people who suffered a very strong covid and ended up needing ECMO or patients who did not require ICU, but whose lungs have a serious affectation, such as fibrosis, and do not improve. In any of the cases, adds Jáuregui, patients have to meet several requirements: not be positive for covid, that no other vital organ has failed, that the patient is conscious and,in case of being connected to ECMO, that it takes more than two months with this treatment.
Soriano had more than four and met the rest of the requirements.
“We sent a team to see the patient, we met him, we spoke with him and we decided to bring him to Vall d'Hebron with the idea that he would enter the urgent waiting list for a transplant.
After four days, we had compatible lungs ”, summarizes Jáuregui.
In the eyes of the patient, there was no other alternative either: "I've always seen the situation complicated, but at that time, it was the transplant or being plugged into an artificial lung," says Soriano.
In the image, Soriano shows the scars after the transplant.Albert Garcia / EL PAÍS
In a race against time - so that the organ does not fail, health teams have only eight hours from when they extract the donor's lungs until they are implanted in the recipient - a multidisciplinary group of 15 professionals participated in Soriano's intervention. The operation lasted a whole night, nine hours to remove those damaged lungs and implant the donated organs. “We were impressed because Jordi's lungs were very deteriorated. We had not seen such a large swelling. They changed color because the blood did not enter them. Furthermore, as he was connected to ECMO, the blood left the heart and no longer passed to the lungs ”, recalls the doctor.
When the donated organs were transplanted, the medical team took a breath. And Soriano's new lungs, too. “Suddenly my lungs were pink again and they were working on their own. It was a spectacular moment, like a miracle ”, the doctor resolves. Soriano left the operating room "with 92 staples", apostille, and the ECMO plugged in, but, in a few days, the doctors removed the device and all the ventilatory support and he began to breathe on his own.
Now, what is most pressing is to regain muscle mass and mobility lost during his almost five months in the ICU. Several weeks have passed since the transplant and Jordi is immersed in his rehabilitation sessions. You have already started moving your legs on a bicycle and Bernat Planas, your physiotherapist, helps you with exercises to strengthen your diaphragm and breathing capacity. Soriano blows hard through a tube that lifts a red ball into the air. “I'm a bit lazy, but I'm already starting to move my feet and hands, at least. I always look forward ”, he assures. And what more do you want now? "Go home and eat a rice soup with lobster," he resolved convinced.