Some quick thinking and an innovative use of existing technology helped the Health Services Authority and Health City Cayman Islands in saving the life of a Jamaican farmer.
Clester Christie came to Grand Cayman for work but fell ill days after his arrival, and the doctors at HSA and Health City came together to diagnose and cure him of a life-threatening case of leptospirosis.
Mr. Christie, 31, was diagnosed by Dr. Nelson Iheonunekwu, an internal medicine and nephrology specialist at the HSA, and quickly referred to Health City in the East End, according to a press release.
The doctors at Health City confirmed that Mr. Christie was suffering from leptospirosis pulmonary hemorrhagic syndrome, a rare bacterial disease that forms blood clots in the lungs.
Dr. Binoy Chattuparambil, Health City’s chief cardiac surgeon and senior cardiothoracic and vascular surgeon, said Mr. Christie had arrived at the hospital in “a very critical stage.”
“I would say his oxygen level, his saturation level was in the 50s, so if he stayed like that a few more hours he would have arrested. … Within half an hour, we took him to the operating room,” the doctor said in the press release.
The Health City staff hooked the patient up to an Extracorporeal Membrane Oxygenation machine via the venovenous route to support his lungs, marking the first time they had used an ECMO for that procedure. For previous patients, ECMO had been used to support both the heart and lungs.
Dr. Dhruva Kumar Krishnan, senior consultant in cardiac anesthesiology and intensive care, elaborated on why the ECMO support is ideal in helping the lungs recover from leptospirosis. “When the lungs [have] failed to do what [they are] supposed to do,” he said, “we can rest the lungs by bringing the blood out from the body into the [machine and wash] out the carbon dioxide, [add] more oxygen to it and [bring] it back into the heart. So, this machine [helps] the lungs start to function normally.”
The Health City staff learned that both lungs were packed with blood clots and that no blood was able to make it inside the lung. With that knowledge, the staff began performing several complicated bronchoscopies to remove multiple blood clots from the patient’s lungs.
“He had a lot of clots in his lungs so we had to clear them all … at the same time we don’t want fresh bleeding to happen,” said Dr. Krishnan of the procedure. “He slowly improved … but again he started deteriorating when we tried taking this machine off after a couple of days … we had to do repeated bronchoscopy procedures to remove the remaining clots … before he could get better.”
Dr. Mahantesh Patil, medical intensivist at Health City, said he had never seen such a severe form of leptospirosis in 15 years of clinical experience. Dr. Patil also noted that the mortality rate for patients in Mr. Christie’s condition is “extremely high. I would say as high as 70 percent. Despite all support and if you don’t have a facility to do multi-organ support, I would say he had no chance to survive.”
Mr. Christie, a father to two young children, said in the release, “If I never came here, I would have died. If I was in Jamaica, I would have died … they don’t have the same equipment like they do [at] Health City to help me.”