Following a rapid transfer of the patient to the operating theater, he was placed on ECMO life support, which involves channeling the patient’s blood into a roller pump that serves as the patient’s “heart”.
In response to his colleagues’ concern that it might be too late for ECMO in Ebanks’ case, Dr. Binoy was confident: “I told them, if you are not doing it, it’s 100 percent death, if you are doing it then maybe 1 percent … for that patient, it’s the only chance.”
With all hands on deck and team members performing heart massage to keep the patient alive during the procedure, Dr. Binoy recalled that it was an adrenaline-charged and intense scene: “You should have seen the whole team … everyone is up in there doing the massage on one side while we instituted the ECMO to the groin, which took me about 20 minutes.”
The emergency team waited with intense anticipation as the ECMO machine did its work. Within five minutes, Dr. Binoy was vindicated as the patient’s heart slowly resumed beating: “With the ECMO he was getting better, he stabilized and I shifted him to the ICU.”
Next, Dr. Binoy sought to determine what had caused the young man’s heart to stop, and to find a solution. He enlisted the help of the patient’s loved ones in his investigation. “His parents and girlfriend … told us that for the last two weeks he had been very unwell, with shortness of breath,” which deteriorated to the point where he asked his girlfriend to call for an ambulance.
Dr. Binoy quickly recognized the problem when the patient’s mother recalled that her son has been diagnosed with clots in his leg veins on two occasions – the first time in 2005 and again in 2008. After each diagnosis he was advised to take blood thinners for six months and then discontinue the medication.
With this new information in hand, Dr. Binoy immediately ordered a CT scan, which revealed that blood clots were completely blocking both lung arteries. “There was absolutely no blood going to the lungs. So there was only one option: surgery again. From the CT scan room we took him immediately to the operating room … this surgery took almost 10 hours,” the surgeon explained.
The emergency surgery to remove the blood clots is a complicated procedure called a pulmonary endarterectomy, and involves putting the patient on a heart and lung machine. “We had to cool the body to 20 degrees centigrade. I had to drain all the blood from the body, open both lung arteries and remove the clots from both sides,” Dr. Binoy recalled.
To allow the patient more time to recover, he was kept on ECMO for an additional 48 hours, which was needed because his brain did not initially respond well to the treatment. “But after five to six days he was perfect, there was no neurological deficit and he started walking after six days … lung pressure returned to normal, his heart became normal. And after two weeks we sent him home,” recounted Dr. Binoy.
“I’m very happy about the outcome,” Dr. Binoy said, “it’s kind of bringing him from the grave back to life … he is such a young man. It would have been very easy to say he had cardiac arrest and that after 45 minutes nothing more could be done. But we took that 1 percent chance when we decided to put him on ECMO and decided to do the surgery.”
Dr. Binoy expressed his joy at this slim chance of success being realized: “It might have been a 1 percent chance then, but now the patient is 100 percent. For the family they’ve got their son, their boyfriend back, so it’s very, very satisfying.”
Dr. Binoy explained that the delicate and rare pulmonary endarterectomy procedure involves the use of very fine instruments for incisions and the removal of tiny clots from the lungs. “The learning curve for this procedure is very long. That’s why there are only 10 to 20 hospitals where it has been done in the entire world. But the surgery is so gratifying,” he said.
As one of the few surgeons worldwide with extensive experience in the intricate procedure, Dr. Binoy noted: “I have been involved in at least 300 cases of this in India at the hospital where Dr. Devi Shetty, one of the experts in this surgery (and Health City’s founder), was involved. I have seen a lot. I have seen young people, who are unconscious or who are bedridden or on home oxygen, and watched them going back home to their lives.”