Intubated for fifty-eight days, very young, eighteen years old, Francesco (invented name) when all hope seemed lost, made it. Return to breathe, to live, thanks to the intuition and hazard of the doctors of San Raffaele and the Policlinico of Milan, thanks to the excellence of Italian healthcare. It survives the worst aggression of the covid ever recorded in such a young boy and survives an intervention never attempted in Europe, especially in conditions with such high risk of contagion for the team involved.
Francesco is eighteen. It is March 2nd and he begins to have a fever. But it’s a different fever. It doesn’t go away. On March 6 Francesco is so serious that he is taken to San Raffaele. In his region, Lombardy, evil has been raging for two weeks. Two terrible weeks but in which, in record time, thanks to crowding Fedez-Ferragni, a highly efficient intensive care unit was set up in via Olgettina. Francesco is brought there immediately. The respirator and ventilation last seventeen days. But without success. Things are going badly and on March 23 it was decided to connect Francesco to an Ecmo, a device that extracts the blood in a continuous cycle by mechanically oxygenating it.
Francesco is one of the very rare young patients in Italy and in the world to be in such critical conditions. The doctors realize the desperate extraordinary nature of the case and therefore decide to intervene in an extraordinary way. In concert with the Policlinico team, they decide to attempt a risky route only in China, which had never been practiced in Europe at the time (but which will immediately become a school and be imitated in Austria). Contemporary transplantation of both lungs.
An even more complex intervention considering the need to protect all operators from the subtle volatility of Sars-Cov-2. The national transplant center approves the request and on April 30 Francesco officially enters the waiting list. Two weeks ago, finally, the arrival of the donation and the start of the intervention.
Francesco’s lungs appeared wooden, extremely heavy and in some areas completely destroyed – says Dr. Mario Nosotti, director of the School of Specialization in Thoracic Surgery at the University of Milan at the head of the team that operated Francesco – It was then confirmed to microscopic examination a widespread damage to the pulmonary alveoli, now unable to perform their function, with notes of extensive septal fibrosis.
The desperate conditions described by Dr. Nosotti not only make the success of the intervention and the intuition to practice it even more, but they represent a very important case study for research. The organs explanted and so badly compromised will constitute a precious map for the analysis of the aggressive dynamics of the virus.
Nosotti is understandably satisfied and grateful: In addition to the technical skills, I must emphasize the stubbornness and courage of the colleagues of the San Raffaele who, instead of surrendering, have involved us in a solution never attempted before in the western world. Our experience is inspired by that of Professor Jing-Yu Chen of the Wuxi hospital in China, whom we personally know and with whom we discussed some technical aspects, since for obvious reasons he found himself facing the problem before us.
Thanks to Nosotti, Chen and the expertise of a highly trained scientific community, Francesco made it. Today he is awake and is planning a careful physiotherapy that will be able to release him gradually from the respirator. The worst seems to be behind us but certainly rehabilitation will take its time, and prudence. A great good luck from all of us.
Featured image by Luis Melendez on Unsplash