TUSCALOOSA, Ala. (AP) — Robert Moore of Tuscaloosa was kept alive by machines in the intensive care unit for part of November and all of December — his diagnosis: severe pneumonia and the H1N1 flu.
Despite being on a respirator on full force at DCH Regional Medical Center, Moore's organs weren't responding, and his oxygen levels wouldn't stay up. There was a last option, if Moore was going to survive, doctors told his wife Rhonda: He could be taken to UAB for a "last resort" treatment that could save his life.
"It was at that point that I realized how bad it was," said Rhonda Moore, his wife of 26 years. "'You mean he could die from this?' I asked. I was out of my head."
Robert was in good health before his diagnosis. The 46-year-old was the heavy equipment lead man at Thompson Tractor in Tuscaloosa, and he worked out three times a week.
He likely would have died had it not been for a machine normally used for heart and lung transplant patients: the ECMO machine. The ECMO, also known as the extracorporeal membrane oxygenation machine, has recently been used for patients with extreme flu and pneumonia. In the past year, about 15 flu patients have been treated by the ECMO machine at UAB.
None of them had the flu shot, said Dr. Enrique Diaz, medical director of the ECMO program at UAB Hospital.
Robert Moore and his wife were both diagnosed with the flu on Nov. 8. While Rhonda had congestion and coughing and numerous other symptoms, Robert primarily had a high 104-degree fever. Both went to Med Center South and got a couple of shots and medication. But a few days later Robert was still running a fever. A trip to the family's primary physician discovered that he had 70 over 40 blood pressure and severe pneumonia. He was taken by ambulance to DCH.
Still, his health continued to decline.
"They said that if we left him on the ventilator, he had less than a 50 percent chance of making it," Rhonda Moore said. "But on the ECMO he had a 50-70 percent chance."
The ECMO machine works by taking blood from a patient, oxygenating it and then putting it back in the body, allowing a patient's organs to heal when ventilation is not sufficient, Diaz said.
But there is a specific window for when the ECMO machine can work, Diaz said. If a patient is not responding well to a ventilator after three to five days, then an ECMO should be considered, Diaz said. Any longer on the ventilator and it can cause irreparable damage to the lungs, and the ECMO isn't as good an option, Diaz said.
"It's not for everybody, but if the pulmonologist is using 100 percent oxygen and within three to five days it's not working, that's when you have to think outside of the box," he said.
ECMO therapy has been around for more than a decade, but it was only after the 2009 H1N1 flu outbreak when young patients were dying that the ECMO started being used for severe cases of the flu, Diaz said. The big push for ECMO treatment for severe flu/pneumonia cases began in 2013.
While many hospitals have ECMO machines for transplant patients, UAB and Children's of Alabama are the only two hospitals in the state with ECMO programs equipped to treat people with the flu, Diaz said.
"It requires special training and a big team of doctors trained in managing ECMO adult patients," Diaz said.
Robert was taken to UAB on Nov. 18 and remained on the machine for 22 days, battling everything from blood clots in the ECMO machine to a liver reaction from Tamiflu. Robert had to have a tracheotomy so he didn't aspirate and was unconscious for weeks.
"He had been so sick, his doctors said he was their sickest patient," Rhonda said.
The Moores credit the doctors and nurses at UAB — and Dr. Syed Aslam at DCH, who recommended the ECMO treatment — for saving Robert's life.
While most patients stay on the ECMO for seven to 10 days, Robert was on it for 22 days. It took him more than a week to wake up from his medically-induced coma, and even then he couldn't talk due to his trach. He lost 40 pounds while in the hospital, and his muscles became so weak that he had to be in rehabilitative care to gain strength to move his arms and to walk. At first, he could only move his neck. Finally, he was released and went back home Jan. 6.
"It was a miracle. We knew it was a miracle when he was coming off the ECMO machine," said Rhonda, who added that, after 22 days on ECMO, Robert's survival rate was closer to 30 percent. "You have your doubts when you are seeing what you are seeing, but we never gave up hope that he would survive, and asked the Lord for mercy."
It was the technology, along with God's grace, that got him through it, she said.
"I'm thinking my husband would not be here without this," Rhonda said.
Robert said he's thankful to his wife for staying by his side through the experience and thankful to the Lord. He also hopes ECMO therapy for flu patients becomes more widespread.
"It's one reason we are trying to help get the word out, because these flu patients are dying all over from what we are hearing," Robert said. "This technology definitely saved me."
Information from: The Tuscaloosa News, http://www.tuscaloosanews.com