ST. LOUIS — Five days into being kept alive by the most invasive kind of life-support machines because of his COVID-ravaged lungs, 27-year-old Bryan Glebavicius’ heart stopped. Doctors had asked his family if they wanted him resuscitated.
“We said yes, to bring him back,” said his mom, Pat Chrismer-Glebavicius, 65, of Maryville, Illinois. “I don’t know a parent that wouldn’t say yes.”
Glebavicius, a diesel mechanic from Wright City, went on to spend a total of 78 days on an ECMO machine at SSM Health St. Louis University Hospital — a record for the hospital — his blood pumped from his body to an artificial lung and then back in.
ECMO, or extracorporeal membrane oxygenation, is considered a Hail Mary pass in an effort to save a life, a bridge therapy to give the heart and lungs time to heal. It can only be used under strict circumstances. In Glebavicius’ case, he was young and otherwise healthy.
But Glebavicius’ lungs have not healed. The inflammation caused by COVID-19 has left behind scarring difficult to overcome.
People are also reading…
On Jan. 24, he was transferred to Barnes-Jewish Hospital, the only center in the St. Louis area that does lung transplants, where specialists faced a difficult decision about whether to give him new lungs. On Friday, they decided to place him on the transplant list. Glebavicius is still on ECMO.
Before COVID-19, lung transplants for patients on ECMO were rare, explained Dr. Joanna Chikwe, chair of cardiac surgery at Cedars-Sinai in Los Angeles. Patients on life support were considered too sick and weak to likely survive, thus wasting precious donor lungs that are in short supply.
“It’s very difficult to wake somebody up and get them moving, even walking, when they are on ECMO, and that means they have this awful muscle wasting …,” Chikwe said. “As your lungs fail and the ECMO circuit takes over, all of your chest cavity adapts to this, and sometimes the space left for your lungs is really not great; and the muscles that breathe — your diaphragm — wastes away.”
The machine also increases chances of blood clots, bleeding and infections. Those problems are also exacerbated by COVID-19, which can cause strokes and damage to other organs.
Lung transplants have typically been done on patients living at home, perhaps with an oxygen tank, able to do their daily activities, Chikwe said. Their other organs are healthy.
But the pandemic has resulted in doctors using ECMO for more patients and for much longer times, resulting in more patients like Glebavicius whose only chance at life is a lung transplant.
“They’ve really stretched the boundaries of what we thought was possible,” Chikwe said.
Walking a tightrope
Chikwe and researchers at Cedars-Sinai on Jan. 26 released a study of lung transplants during the pandemic to help guide doctors faced with navigating these new and difficult decisions.
They found that of the more than 3,000 lung transplants in the U.S. between Aug. 1, 2020, and Sept. 30, 2021, about 7% were performed to treat severe, irreversible lung damage caused by COVID-19.
Among the COVID-19 lung transplants, whose average age was 52, the three-month survival rate was nearly 96% — similar to that of other lung transplant recipients.
A smaller study by Northwestern Medicine in Chicago, published Jan. 27 by the Journal of the American Medical Association, also found promising outcomes. Of the 30 patients who received donor lungs because of COVID-19 through Sept. 30, 2021, at Northwestern, all were doing well when the study ended in Nov. 15, 2021.
“This study proves lung transplantation is highly effective and successful in critically ill COVID-19 patients,” said Dr. Ankit Bharat, Northwestern’s chief of thoracic surgery. “We hope lung transplantation will become a standard treatment of care when all other medical therapies fail to achieve lung recovery.”
But the decision to try for a lung transplant is still not a slam dunk. It is a risky surgery and recovery that requires perpetual use of medications to suppress the body’s immune system. Despite the medications, the body will eventually begin to reject the donor lungs.
“Probably the biggest dilemma is still understanding whether somebody’s terrible lung damage — and the scans (of COVID-19 patients) that we see are the worst that many of us have ever seen — whether that terrible lung damage is going to be reversible,” Chikwe said.
“Even if you’ve looked after a patient for two, three months and they still have these awful scans, and their lungs look irretrievable, we still don’t know 100% that they might not experience some recovery.”
But the longer patients are on ECMO, the more at risk they are of deadly complications.
“So, you are constantly walking this really high tightrope between the lethality of ECMO and this hope that maybe lungs will recover,” Chikwe said. “But it’s not a tightrope you can walk indefinitely.”
Barnes-Jewish Hospital officials declined to comment for this story.
As Glebavicius and his family waited for him to be added to the transplant list, he fought to build up strength while still on ECMO and a ventilator connected through a hole in his neck.
“He is fighting,” his mom said. “He is a strong-willed young man, and he wants to live.”
‘Fighting for Bryan’
Glebavicius has always been independent, outspoken and stubborn, his mom said. Those traits help him through tough times like this, she said, but they kept him from getting vaccinated against COVID-19.
“I tried to talk him into getting the vaccine I don’t know how many times,” said Chrismer-Glebavicius. “He told me time and time again, ‘I don’t want to hear about it, mom. It’s just the flu, it’s just a virus. I can beat it.’”
Chrismer-Glebavicius described her son as “healthy as a horse.” He was a workaholic, always picking up extra shifts, and loved hiking, fishing and hunting.
He started feeling sick on Oct. 23 and tested positive for COVID-19 the next day. Four days later, he couldn’t breathe and called 911. An ambulance took him to SSM Health St. Joseph hospital in Lake Saint Louis.
“He was scared. He didn’t know what was going to happen to him,” his mom said. “I tried to reassure him that he would be OK.”
On Nov. 1, Glebavicius was intubated and put on a ventilator. Three days later, he was transferred to SSM Health St. Louis University Hospital, where he was placed on ECMO on Nov. 8.
Dr. Ghassam Kamel, the medical director of the intensive care unit at SLU Hospital, said sometimes a COVID-19 infection can be so bad that a ventilator is not enough to maintain oxygen levels. And they can be otherwise healthy enough to warrant further intervention.
“Even patients who are young, without obvious medical problems or the known risk factors that we know of now like diabetes or obesity or any other disease — we’ve seen those patients also still get sick enough that they require the most advanced kind of life support,” Kamel said.
The number of ECMO patients at SLU Hospital went from 17 before the pandemic in 2019, to 47 last year, hospital officials say. The number of hours patients spent on ECMO those years went from 1,946 to 21,538.
Glebavicius spent 78 days at SLU Hospital on the machine, tripling the previous record of 26 days.
Chikwe said Cedars-Sinai has between five and 10 patients using ECMO at any given time. Before the pandemic, it was one or two.
Care for patients on ECMO is complex, and it takes a huge effort to get them to the point where they either get better or can be considered for a transplant.
Around Thanksgiving, the team began slowly bringing Glebavicius out of sedation. They began searching for transplant centers across the Midwest to take him. Last year, the hospital referred three ECMO patients to transplant centers.
The process was heartbreaking, his mom said.
Some wouldn’t accept him because his insurance did not cover enough of the cost. Others refused because he was so weak. The team at SLU Hospital worked to get him supplemental insurance through Medicaid. They tried to build his strength.
On Dec. 15, Glebavicius was able to sit up for a while. A week later, he stood. He walked on Jan. 12 — a massive undertaking that requires a team of five or six people to monitor and move his equipment along with him.
The five feet he walked turned to 14, then 22. His mom or his brother, Alex, 25, were there to cheer him on.
Barnes-Jewish finally agreed to accept Glebavicius, and he moved to the hospital a few miles away on Jan. 24. Last year, Barnes-Jewish completed 70 lung transplants, the 11th most in the country.
Chrismer-Glebavicius broke down in tears describing the effort by SLU Hospital: “If it hadn’t been for them fighting for Bryan, I don’t know where we would be now.”
As Glebavicius grew stronger and was able to communicate through writing or mouthing words, his mom said he was regretful. He told her that he wished he had listened. That he was so stupid for not getting vaccinated.
“I told him, no you are not,” said Chrismer-Glebavicius, crying once more. “It was just how you thought things were, how you perceived everything.”
At Barnes-Jewish, Glebavicius has gotten stronger. On some days, he is able to walk more than 320 feet, his mom said.
Four days after he arrived, providers temporarily placed a special valve over the breathing tube going into an incision through his neck and lowered the fluid holding it in place. That allowed enough air to pass over his vocal chords.
For the first time in 90 days, Chrismer-Glebavicius heard her son tell her he loves her.
He told jokes, asked about his truck and whether he still had a job, his mom said. He had a lot he wanted to say.
He talked about their trip to Alaska, which the Make-A-Wish Foundation provided for their family before his older sister died 12 years ago of a brain tumor at the age of 21. He talked about his dad, who died three years ago in a car crash.
“I think it just hit home for him,” his mom said. “How life is really too short, and it can be taken away any time.”
On Jan. 31, he got his first COVID-19 vaccine shot.
Chrismer-Glebavicius said her son seems embarrassed by her telling his story. He doesn’t understand why anyone would be interested.
“It’s not about you, Bryan,” she told him. “Hopefully, it will convince people to get the vaccine.”
Dr. Reinaldo Rampolla is the medical director of the lung transplant program at Cedars-Sinai and one of the authors of the study suggesting that lung transplants are a safe option for select patients with the most severe lung damage from COVID-19. He wished the study wasn’t needed.
“Our hope,” Rampolla said, “is that no one has to go through ECMO or lung transplant because of COVID-19. The best protection we have against severe, aggressive disease is vaccination.”