A second sigh of relief: ECMO saves recovering cancer survivor from lung failure
From cancer survivor to lung failure, Joey Porch’s journey took a miraculous turn with the help of the Penn Lung Rescue team, providing a lifeline for his failing lungs.
Most days began with Joey Porch at his demanding job as the manager of a popular Chislehurst, NJ bagel shop, where he would routinely work on his feet. However, consistent back pain eventually sent him to the emergency room, beginning an eight-month journey that nearly ended his life.
“I thought maybe it was something wrong with my kidneys, but some scans showed my lymph nodes were swollen,” recalled Porch. Further tests in September 2022 would reveal testicular cancer, leading the husband and father of a three-year-old to an aggressive and grueling chemotherapy treatment for the next several weeks. After some days of being so sick he could not move, the long weeks paid off: Porch had beaten his cancer. “I was so excited. I told my boss that I’ll be back to work in two weeks. But then the lung stuff hit me.”
The “lung stuff” Porch referred to was that one of the chemotherapy drugs had caused complications, plunging him into the depths of lung failure. His life hung in the balance while he lay intubated in a South Jersey intensive care unit, unconscious for the next month.
‘I want Penn Lung rescue’
By February 2023, things were dire. Porch’s breathing worsened as he remained unconscious and intubated. Porch’s wife, Haley, already knew who to call if his condition worsened.
“I looked at his care team and said ‘I want you to call Penn Lung Rescue’,” she recalled, remembering a family friend who had been saved by the program. Launched in 2014, the Penn Lung Rescue Team is a group of Penn doctors and medical staff trained to deploy mobile extracorporeal membrane oxygenation, or ECMO, for those in acute respiratory failure. ECMO is a mechanical device that temporarily replaces the work and function of injured lungs. It is often used while a patient awaits a transplant, but for some patients it gives the lungs a chance to recover and get stronger. When patients with severe respiratory failure are too unstable to transport, the Penn Lung Rescue Program dispatches a team from Penn to bring a mobile version of ECMO to a patient who is in an outside facility, then safely returning to Penn Medicine.
Porch’s care team made the request for Penn Lung Rescue team and Audrey Spelde, MD, an assistant professor in the Department of Anesthesiology and Critical Care and a Penn Lung Rescue team member, was one of the people who answered the call. “Like each patient who receives care from Penn Lung Rescue, our team had a conversation to see if ECMO was a good fit for Joey,” Spelde recalled. “We decided that even if he wasn’t a transplant candidate, that we should still put him on ECMO, give him steroids, and see if his lungs recover,” she added.
The Penn Lung Rescue team successfully transported Porch to Penn Presbyterian Medical Center on February 26, but Haley recalled that the team was still unsure about his fate. “It was made clear to me that they were going to try to reverse his lung failure,” Haley said. “They also let me know it might not work and that it could get to a point where I would need to make the decision to keep him on life support or not. Those were the worst days of my life.”
A lifesaving bridge
The mobile ECMO team placed Porch on ECMO at the South Jersey facility where he was receiving care, before safely transporting him to Penn Presbyterian Medical Center. He began a steroid treatment aimed at improving his lung function. To his care team and family’s disappointment, the steroids were not leading to any improvement in his lungs. Doctors then made the decision to switch Porch from veno-venous ECMO, to veno-pulmonary ECMO.
Veno-venous ECMO solely supports a patients lungs , while veno-pulmonary ECMO provides both lung support and right-sided heart support. The choice between the two methods depends on the specific condition and needs of the patient, as determined by the medical team. “Joey had baseline kidney disease and we were determined to make sure it did not progress to the need of dialysis, because then he would no longer be eligible for a lung transplant,” Spelde said. Right ventricular dysfunction is common in those with severe lung disease, which can lead to renal failure.
The veno-pulmonary ECMO did not lead to any significant improvement to Porch’s lungs, though it did allow doctors to remove Joey from a sedated state and transfer him from Penn Presbyterian to the Hospital of the University of Pennsylvania, where most transplant evaluations and surgeries take place in the state-of-the-art new Pavilion building. It’s a move that, Spelde says, could not have happened if ECMO had not kept Porch alive. “ECMO can serve a different purpose for different patients. For most, it is a bridge to lung recovery. In Joey’s case, this was a bridge to decision making and a bridge to transplant,” said Spelde.
‘They never stopped fighting for Joey’
Doctors were able to prevent kidney disease from developing, and by April Joey was well enough for a bilateral lung transplant. After a successful surgery, he remained on ECMO for three days before he was removed from the machine on April 12. Breathing on his own, Joey began the recovery process. Within just days of his lung transplant, he was walking around the hospital floor. He made so much progress that after a month he was discharged and cleared to go home, avoiding the need for more rehabilitation at another facility.
His homecoming was one his wife and daughter were waiting for.
“We didn’t let my three-year-old, Emelia, know that I was coming home that day. So when I walked in the door she was in shock. Then she started jumping up and down,” said Porch. Haley, chimed in, “We are forever grateful to the team at Penn. They gave my daughter her daddy back. They gave me my husband back. When things went wrong they never stopped fighting for Joey.”
Learn more
Joey Porch’s story is just one of countless others of people saved by ECMO. You can learn more about the Penn Lung Rescue team on the website, or watch the video below for more patient stories.