COVID recovery included long stay on ECMO, double-lung transplantApr. 1, 2021, 9:38 AM
by Matt Batcheldor
Zach Lloyd was only 37 years old with no pre-existing health conditions, but COVID-19 was bringing him within an inch of his life.
Beginning in October 2020, he lay immobile in a bed at Vanderbilt University Medical Center, hooked up to a life-sustaining mechanical system called ECMO, or extracorporeal membrane oxygenation, which can temporarily take over for the heart and lungs of critically ill patients. He primarily needed it for his lungs, badly damaged by the coronavirus.
He would remain on the system for 95 days, far exceeding the time most patients spend on it. In a rare move, Lloyd was on not one, but two ECMO circuits, a maze of tubes carrying blood back and forth, keeping him alive.
And then, a miracle. In January, Lloyd received a double-lung transplant that was his only shot at life. Now in rehabilitation, Lloyd looks back on spending more than four months in the hospital — including Thanksgiving, Christmas and his birthday — much of that time fighting for his life.
“Without the dedicated actions of the COVID-19 Intensive Care Unit, Medical Intensive Care Unit (MICU), Cardiovascular Intensive Care Unit (CVICU), and ECMO teams, he would not be alive today. They literally gave him a chance to live,” said Lloyd’s transplant surgeon, Matthew Bacchetta, MD, MBA, MA, associate professor of Thoracic and Cardiac Surgery.
It all started in early October 2020. Lloyd, the pastor of East LaFollette Baptist Church in East Tennessee, had a high fever and cough that weren’t getting better after a week. “He just couldn’t rest,” said his wife, Sara. “He just couldn’t get comfortable.”
The Lloyd family was all isolated at home. Zach, Sara, and their 10-year-old daughter, Lily, all tested positive for COVID-19. Their 6-year-old son, Titus, had symptoms but tested negative.
Sara, who is the operations manager at LaFollette Medical Center, dropped her husband off at the emergency room there to be evaluated. At that point, Zach was able to walk in the hospital doors for treatment. But his condition took a quick turn for the worse.
He was placed on oxygen and quickly went from requiring 6 liters to 30. He was transferred to Methodist Medical Center in Oak Ridge, Tennessee, to receive a higher level of care.
“It’s like I walked into a different world,” Lloyd said, “because when they wheeled me in, they literally put a plastic cover over the top of the gurney, the transport, and wheeled me into this COVID area. I just remember looking through the plastic thinking, what in the world have I got myself into?”
His condition only worsened; he was eventually placed on a ventilator. As his situation wasn’t improving, his medical team arranged for VUMC’s ECMO team to begin his ECMO treatment there, then continue it en route to the COVID-19 unit at Vanderbilt University Adult Hospital.
“He needed so much oxygen, it was my understanding that they didn’t feel comfortable transporting him without him being on ECMO,” Sara said.
Lloyd entered the COVID-19 Intensive Care Unit, where everyone is in full personal protective equipment. Visitation is limited to a couple of hours, even though visitors sometimes drove longer to get there, to peer through glass at their loved ones because they’re not allowed in patient rooms.
Lloyd remained in the COVID-19 ICU as long as he was positive for the coronavirus. Sara had to go to work and care for their two young children in LaFollette, more than four hours away. She would call for updates before getting them ready for school, at lunch, after work and after the children were in bed. Infrequently, she was able to see Zach over Zoom and read his lips, as he was unable to speak. A caregiver held up an iPad so Zach could communicate.
None of this made any sense. Why was a 37-year-old man with no known health conditions on the brink of lung failure because of COVID-19?
“I don’t think anybody knows why it impacted his lungs the way that it did,” Sara said. “Everybody is just dumbfounded by why.”
After a couple of weeks, Zach tested negative for COVID-19 twice and therefore was transferred to the Medical MICU. There, Sara was able to visit Zach normally and spend the night. At this point, Zach’s recovery was far from certain.
“We had him on very high amounts of various medications just to keep him sedated and breathing right,” said Madison Keyes, RN, one of Zach’s nurses in the MICU. “It was just hard. We had so much trouble weaning his medications down. It wore on us, because the longer you have a patient, the more attached you get to them.”
His ECMO team was at his side, including ECMO fellows Yatrik Patel, MD, and John Stokes, MD, and Whitney Gannon, MSN, MS, assistant in Medicine.
Lloyd’s lungs were badly damaged, and he needed a transplant, but he was also immobile. And there was little precedent for transplanting lungs into a COVID-19 patient — just a handful of cases nationally.
“In order to get listed for any kind of a transplant, the patient has to be pretty sick, but they also can’t be so sick that they won’t do well once they get the transplant,” said Jessica Bowman Williams, RN, CCRN, program coordinator in the CVICU, where Lloyd would spend time after the MICU. “In his case, his only option for survival was to get a lung transplant. But in order to get listed for transplant, he needed to prove that he could mobilize and rehabilitate.”
Patel proposed that Zach use a new supine bicycle. The bike, which the CVICU had just acquired, allows patients to essentially pedal in a hospital bed. Zach took to the bike immediately, setting goals for time on the bike and resistance, just as he would do on his stationary bike at home, which happened to be his exercise of choice.
“Even on weekends and holidays, Yatrik and I coordinated and met in the MICU to get Zach on the bike,” Williams said. “It was precarious with the two ECMO circuits (two large cannulas went into bilateral groins while two additional cannulas went into his internal jugular veins in his neck), but we made it happen as safely as possible while getting him mobilized. Sometimes some of our CVICU nurses would go up with the bike as well, if I could not. It was a team investment in his mobility.”
Lloyd spent enough time on the bike to attract the notice of the transplant committee that determines who will be good candidates for transplants, and Zach passed the test. He was placed on the transplant list on Christmas Eve, and Bacchetta transplanted his two new lungs on Jan. 28. The cardiothoracic anesthesia team included Bantayehu Sileshi, MD, associate professor of Anesthesiology, and fellow Karl Hillenbrand, MD.
Zach recalled his pulmonologist, Katie McPherson, MD, assistant professor of Medicine, describing them as a perfect match — like having a No. 1 draft pick and being able to pick Tom Brady or Peyton Manning.
“Essentially we were waiting for perfect lungs,” McPherson said. “When we found them, we went for it because it was Zach’s only chance at survival.”
After 124 days at VUAH, Lloyd was released to begin his physical rehabilitation at Vanderbilt Stallworth Rehabilitation Hospital. He said his strength is returning, little by little, and he longs for the day when he can return home to his wife and children.
“If there’s anything I could tell somebody, it is, have hope,” Lloyd said. “There’s been a lot of dark days, but have hope that eventually it’s going to be better.”