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The Straits Times
Oct 28, 2022
His knee pain suddenly became worse and he began to experience chest pain. Mr Dante Lin’s oxygen levels were low and his heart was weak, and the 18-year-old was not responding to any treatment.
Doctors at the National University Heart Centre, Singapore (NUHCS) told his mother, Mrs Amy Lin, 41, that he was on the verge of cardiovascular collapse and death.
But they offered a lifeline – to put him on extracorporeal membrane oxygenation (Ecmo) life support.
It was the first time Mrs Lin had heard of such a treatment, and even though she did not fully understand what it was then, she agreed.
That saved her son’s life.
Ecmo is a life-saving machine that takes over the function of the heart and lungs. It is a highly specialised and complex form of life support and is used on the most critically ill patients when no other treatment works.
It is also very resource-intensive and requires an experienced team of medical experts, including specially trained nurses, perfusionists, cardiac surgeons and intensive care unit physicians.
For 62 days, Mr Lin was hooked onto the Ecmo machine. It helped to supply oxygen to and remove carbon dioxide from his blood. At times, it took over the function of his heart.
After spending a total of 98 days at the Cardiothoracic Intensive Care Unit (CTICU) in NUHCS, Mr Lin was discharged on Sept 26 to tears and applause from the medical team.
Doctors subsequently found out that the knee pain, which began after the family returned from Malaysia in mid-June, was triggered by bacteria – a staphylococcus aureus (also known as “golden staph”) infection. The bacteria entered Mr Lin’s bloodstream and quickly spread to his lungs.
He developed septic shock at Khoo Teck Puat Hospital, where he was first admitted to. When he became unresponsive to treatment, the Ecmo team at the National University Hospital (NUH) was called in, and he was subsequently transferred there.
Septic shock is a life-threatening condition when the blood pressure falls to dangerously low levels during an infection.
NUH treats about 40 to 50 patients on Ecmo a year now. Mr Lin was on Ecmo for longer than most patients, as the average time is about one to two weeks.
Associate Professor Graeme MacLaren, the director of the CTICU in NUHCS who oversaw the care of Mr Lin, said on Friday: “It was highly likely that Mr Lin would have died that same night had he not been stabilised with Ecmo. It is essentially a heroic form of life support, used only for the sickest patients for whom no other treatment has worked.
“Ecmo’s use is increasing worldwide, in part because of the Covid-19 pandemic, but also because clinicians are becoming more skilled at using it.”
Mr Lin is the first NUH patient whose septic shock was so severe that it required Ecmo. The use of Ecmo in septic shock cases is extremely rare, even in the world’s busiest Ecmo centres, Prof MacLaren added.
For 98 days, Mrs Lin visited her son daily. The mother of four children took time off her work as a retail training and customer service manager to be with him. Mrs Lin left the other three children, aged 17, 11 and five, in the care of her in-laws. Mr Lin is her oldest child.
“The whole medical team gave me a lot of hope, despite being very honest about my son’s condition,” she said. “There were times when my son’s condition got better and at times, it worsened.”
She added: “I also had a great support system from my family and relatives, as well as my husband, who took every opportunity to visit Dante when he was off work. I am just very glad that he is here with us.”
The bill came to a staggering $490,000, Mrs Lin revealed, but they did not have to fork out a single cent from their pocket. Various government subsidies, insurance and MediSave helped them pay the bill.
After spending some three months intubated and in bed, Mr Lin lost about 12kg, and is currently working with a rehabilitation team comprising nutritionists and physiotherapists to regain muscle and lost strength.
So far, his recovery has been good. He is able to walk normally, but is still unable to run or jump.
He said: “It felt like I went to sleep and woke up the next day, only to realise that two months had passed. When my parents and doctors told me that I was in such a severe condition and almost died, I got a shock. It was so overwhelming and unbelievable.”
On Friday, Prof MacLaren also launched the latest edition of a book on Ecmo, titled Extracorporeal Life Support: The ELSO Red Book, which is the definitive reference text on Ecmo.
Prof MacLaren is the editor-in-chief of the book, which was jointly written by over 200 leading expert clinicians worldwide.