Heart-lung bypass a COVID-19 rescue tool in Minnesota

John Grubb was something of a celebrity when he left HCMC on Monday — crowds gathered for pictures at his bedside and nurses hugged the St. Michael, Minn., man and said goodbye.

When severe COVID-19 leaves you on a heart-lung bypass machine for 81 days, and you make it out of the hospital alive, you tend to get noticed.

"That's the longest we've had a survivor on veno-venous ECMO so far," said Dr. Matthew Prekker, a medical director of HCMC's ECMO program, who treated Grubb. "He's had the longest duration of support and fortunately is going to be a survivor."

ECMO is short for extracorporeal membrane oxygenation, a treatment of last resort that takes over the role of pumping oxygen and blood when the lungs are too weak to keep up. Globally, survival has been just a little better than 50-50 when COVID-19 patients end up needing ECMO for 60 days or more, but Twin Cities doctors said a combination of smart patient selection and patient critical care has pushed local survival rates above that.

A consortium of four Minnesota providers published data this month showing a 60-day survival rate of 74% in an initial group of 35 patients who received veno-venous (or VV) ECMO. Patients getting VV ECMO have their blood diverted out and mechanically oxygenated before it is run back into the body and through the lungs.

ECMO has been used for more than 100 COVID-19 patients in Minnesota and has been involved in some high-profile survival stories — such as Ironman athlete Ben O'Donnell and pianist Nachito Herrera.

Prekker said ECMO itself doesn't treat COVID-19 or its complications, but it gives the lungs and heart a break. The average duration of ECMO treatment has increased substantially in the COVID-19 era, he added, and doctors have learned they sometimes need to resist their urge to intervene and "sit on our hands" while healing takes place.

"It's really illustrated to me, having seen survivors after 50 or 60 or 80 days of ECMO, how resilient the lungs are," Prekker said. "They do have the chance to heal. We just need to give them enough time, as long as we're seeing other markers of success."

Grubb, 58, suffered COVID-19 after his wife and daughters were infected with the coronavirus that causes the respiratory disease the week before Christmas.

While their illnesses were mild, Grubb quickly found himself unable to breathe because a prior lung disorder complicated his case. ECMO was considered after a ventilator pushing air into his lungs at full capacity at North Memorial Health Hospital couldn't maintain adequate blood oxygen levels.

"They said there was nothing else they could do," said his wife, Kelly Grubb.

Grubb is one of 30,370 Minnesotans who have been hospitalized for COVID-19. State health authorities on Monday reported another three COVID-19 deaths and 1,105 diagnosed infections, bringing the state's totals in the pandemic to 7,163 deaths and 580,340 infections.

Health officials are encouraged by signs that Minnesota's third pandemic wave peaked. The seven-day average positivity rate of COVID-19 testing rose from 3.5% on March 3 to 7.5% on April 8 before dropping back to 6.2%.

Health officials credited Minnesotans for limiting the wave through mask-wearing, social distancing and progress in vaccination. Nearly 2.6 million people have received at least first doses — equating to 59% of the state's eligible population — and nearly 2 million of them have completed the one- or two-dose series.

Doctors with the consortium said those public health efforts also kept the pressure off hospitals — to the point that ECMO was always within a few hours of being available when patients needed it.

Providers as a result never had to make rationing decisions — choosing between patients who both needed ECMO to survive, said Dr. Melissa Brunsvold, director of ECMO for M Health Fairview, which is also part of the Minnesota consortium.

The doctors have learned which patients need this limited, intensive and costly form of care the most if tough decisions ever need to be made, she said. The consortium is in the process of publishing a Minnesota scoring system for screening patients for ECMO.

"We're able to help predict who is going to do best, and then who will survive possibly without needing it, and who is least likely to survive," she said.

Grubb had frightening moments this winter with infections and blood clots and complications that had his wife convinced he was going to die, but then he would recover. Eventually he was taken off sedation while on ECMO and switched from a breathing tube down his throat to one through a surgical incision in his neck that allowed him to communicate and eventually speak.

His first chance to communicate was by using goggles on his eyes to pick letters on a tablet and spell words. An engineer for a power company, his first inquiry was about a colleague and progress on a redesign plan for nuclear power.

" 'OK John,' " his wife teased. " 'Me and the girls are OK, too. Don't worry about us.' "

Grubb will remain on a ventilator to continue healing after he is transferred to Regency Hospital, a long-term acute care facility in Golden Valley. Physical and occupational therapists worked with him at HCMC, even while he was receiving ECMO, to practice sitting up and standing and to build back muscle strength.

The family is hopeful that will hasten his recovery. Grubb and his wife have a dream plan to return to Italy for vacation.

Grubb had survived a nervous three weeks there years earlier when a nebulizer he needed for his lung disorder broke. The family threw coins in the Trevi Fountain in Rome and figured it gave him good luck to get through the trip without needing a replacement or hospital care.

"We want to go back to Trevi Fountain," his wife said, "and give it some more money."