Faculty and clinical staff from both USF Health and Tampa General Hospital learned the nuances and best practices of ECMO (extracorporeal membrane oxygenation) at a special course held on the TGH campus last month.

The recent ECMO course provided the newest information associated with the life-saving procedure and was led by Kapil Patel, MD, associate professor and director of the USF Health Center for Advanced Lung Disease in the USF Health Morsani College of Medicine and director of the TGH Lung Transplant Program, and M Raheel Qureshi, MD, assistant professor and associate medical director of the ECMO program in the Division of Pulmonary, Critical Care and Sleep Medicine in the USF Health Morsani College of Medicine, and associate director of the Lung Transplant Program at Tampa General Hospital.

ECMO is used in critical care situations, when the heart and lungs need help as the patient heals. In ECMO, blood is pumped outside of the body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body.

This method allows the blood to “bypass” the heart and lungs, allowing these organs to rest and heal.

Many providers and hospitals around the world saw an uptick in patients needing ECMO as part of the COVID-19 care they received in intensive care units. Now, as COVID continues to subside, expanding training on ECMO better prepares health care teams and hospitals if another surge of COVID – or other related viruses – take hold.

Published studies show that hospitals and facilities with more ECMO experience have better outcomes. ECMO is complex in its execution, requiring trained staff and specialist equipment, making the USF Health/TGH training course a critical part of preparation for another COVID surge or pandemic.

Health care providers across the country learned very quickly during the pandemic that ECMO could save lives and it was used largely in patients with COVID-19 with acute respiratory distress syndrome (ARDS). Published studies show importance of carefully selecting patients for a critical care treatment requiring intense staffing, specialized equipment and advanced expertise.

The USF Health/TGH training sessions mean that more providers are prepared to treat patients sooner with ECMO and improve outcomes.

Photos by Freddie Coleman and Ryan Rossy, USF Health Communications

There were tears of joy from 65-year-old Jeanette Ebaugh, who recently received the 500^th lung transplant from Tampa General Hospital (TGH).

Ebaugh celebrated the successful procedure, alongside her husband and the team of health professionals who saved her life, during a press conference March 8 at TGH.

“I have my life back,” Ebaugh said. “This is the best I’ve felt in more than three years. Now I can breathe on my own without the help of oxygen. I feel very lucky.”

USF Health pulmonologist Dr. Kapil Patel, assistant professor of medicine and director of Lung Transplantation and Interstitial Lung Disease at the USF Health Morsani College of Medicine, with Jeanette Ebaugh, who received the 500th lung transplant at Tampa General Hospital.

The team that prepared Ebaugh for the lung transplant, provided surgical and post-surgical care and continues to carefully monitor her progress is led by Kapilkumar N. Patel, MD, assistant professor and director of the Lung Transplantation and Interstitial Lung Disease, Division of Pulmonary and Critical Care Medicine in the Department of Internal Medicine at the USF Health Morsani College of Medicine, and Christiano Caldeira, MD, associate professor and division chief of Division of Cardiothoracic Surgery in the Department of Surgery at the USF Health Morsani College of Medicine.

Tampa General is the 26th hospital in the nation to perform 500 or more lung transplants.

Dr. Patel and Dr. Caldeira were at the press event to share the TGH’s milestone and the success of the Lung Transplant Program – now the 26^th hospital in the nation to perform 500 or more lung transplants.

“We started the transplant program at TGH in 2002,” said Dr. Patel, the USF Health pulmonologist who is medical director for the lung transplant program at TGH. “Since then, we’ve completed 35 to 40 transplants every year. Lung transplants are the longest and some of the most complex surgeries, but we’ve been able to complete them successfully.”

Ebaugh, from Port St. Lucie, Florida, was diagnosed five years ago with idiopathic pulmonary fibrosis, an incurable lung disease, at another hospital, and was told she had five years to live. But, in 2015, doctors at TGH gave her hope and placed her into the TGH’s lung transplant program waiting list for a single lung transplant. After 22 months, TGH found Ebaugh’s organ donor match. Her surgery took six hours.

“Thank you to the donor and their family,” said Ebaugh, as she got emotional. “Without their generosity I would not be here. Thank you to my doctors and the wonderful staff at TGH. Thank you for giving me a new life.”

TGH partnered with LifeLink Foundation to find the organ donor. The non-profit organization is a locally federally designated agency that handles the recovery of organs for transplantation in 15 counties in west Florida.

“Ebaugh is one of the success stories,” said Betsy Edward, senior public affairs coordinator for LifeLink Foundation. “But we still have 120,000 patients on the national organ transplant waiting list hoping for their own successful outcomes. We want to reiterate that without the generosity of another family’s organ donor, Ebaugh would not be here today. So, I encourage others to help make a similar donation to save lives.”

From left: Dr. Christiano Caldeira, associate professor and chief of the Division of Cardiothoracic Surgery at the USF Health Morsani College of Medicine, Dr. Patel and patient Jeanette Ebaugh answer media questions at the press conference.

Dr. Caldeira, who performed the lung transplant on Ebaugh, said TGH has reached this milestone because of an effective interprofessional collaboration between various health professionals and organizations. “It takes a lot of people to make this a success, and we wouldn’t have been able to achieve this accomplishment without the excellent coordination of the surgical team, TGH’s lung transplant program, Dr. Patel, LifeLink and others,” he said.

TGH has one of the busiest transplant centers in the country, performing transplants in adult lung, heart, kidney, pancreas, liver and pediatric kidney.

Dr. Patel joined USF Health and TGH in 2016 to help lead and strengthen the Lung Transplant Program at Tampa General Hospital while strategically working to create a Center of Excellence for Advanced Lung Disease.

“I wouldn’t have come here if the recipe wasn’t right for success,” Dr. Patel said. who was recruited from Stanford University Medical Center. “The program has such a strong foundation, and it will only get better from here.”

Story and photos by Vjollca Hysenlika

Dr Kapil Patel was recruited from Stanford University known for its preeminent center

Pulmonologist Kapil Patel, MD, arrived at USF Health full-time Sept. 1 with one overarching goal in mind: to help lead and strengthen the Lung Transplant Program at Tampa General Hospital while strategically working to create a Center of Excellence for Advanced Lung Disease.

He came from Stanford University Medical Center, home to one the few such specialty pulmonology centers in the United States, which is known for its exceptional patient outcomes and consistently ranked by U.S. News & World Report as one of the best in the nation.

Pulmonologist Dr. Kapil Patel was recruited to the USF Health Morsani College of Medicine from Stanford University Medical Center.

“Dr. Patel’s recruitment is significant for USF Internal Medicine, the patients of USF Health and Tampa General Hospital and the community at large. His move from Stanford University to head the lung transplantation program is a landmark, making this the first solid organ transplant program to be part of USF in 35 years,” said John Sinnott, MD, chair of the Department of Internal Medicine, USF Health Morsani College of Medicine. “Dr. Patel’s vision for a center for advanced lung disease will place USF and Tampa General at the forefront of caring for patients with lung diseases in the United States.”

A center like the one at Stanford promotes continuity of care, allowing patients to be conveniently treated in one place by physicians who subspecialize in complex lung disorders, while cohesively providing the latest advances in medical and surgical care, said Dr. Patel, assistant professor of medicine in the Morsani College of Medicine’s Division of Pulmonary, Critical Care and Sleep Medicine and medical director for lung transplant, interstitial lung disease and adult cystic fibrosis.

“As you bring academic research to the forefront, it also opens opportunities for patients to participate in clinical trials that can afford alternatives to treatment they may not otherwise receive elsewhere,” he said.

Dr. Patel most recently directed the Stanford’s Interstitial Lung Disease (ILD) Program, one of the arms of the medical school’s Center for Advanced Lung Disease. He helped build physician referrals to Stanford’s ILD program from 100 to more than 200 in just over two years.

Providing integrated subspecialty care for complex lung diseases

Dr. Patel says he was attracted to USF Health by the opportunity to serve as medical director of an academic-affiliated lung transplant program and to build upon the solid foundation laid by Tampa General’s transplant team to create what could be Florida’s first center for advanced lung disease.

He plans to work with colleagues in USF Health Internal Medicine and Tampa General over the next several years to develop a center of excellence serving as the umbrella for four interconnected programs:

• Lung Transplantation: Tampa General already has an active program accredited by the United Network of Organ Sharing – one of five in Florida – and has performed more than 480 total adult lung transplants (single and double) since 2002. The program’s one-year patient survival rate of more than 91 percent and three-year survival rate of more than 71 percent both exceed national survival rate statistics. Dr. Patel plans to selectively grow a larger program.

“Selective is the way to go to do the right thing for patients. It is critical to identify appropriate candidates in need of transplant and to understand the limitations to transplant, so you do not push the limits too far,” he said. “We want to be confident that the surgery will go well, so the patient leaves the hospital with a new life.”

Since arriving here, Dr. Patel has worked closely with USF Health-affiliated cardiothoracic surgeon Christiano Caldeira, MD, of Florida Advanced Cardiothoracic Surgery, who serves as surgical director of the heart and lung transplant programs at TGH. They take donor calls together, jointly decide which donor organs are the healthiest for recipients, and co-manage lung transplant patients in the intensive care unit (ICU).

Dr. Patel with Nicole Davis, RN, a lung transplant coordinator at Tampa General Hospital.

• Interstitial Lung Disease, or ILD (also known as pulmonary fibrosis): This new program would manage the care of patients with a group of lung disorders causing tissue deep in the lungs to progressively stiffen and scar, which affects the ability to get enough oxygen into the bloodstream. Currently, Dr. Patel said, Florida has no ILD program certified by the Pulmonary Fibrosis Foundation (PFF) Care Center Network. Dr. Patel will lead an initiative by USF and TGH to establish the first.

• Cystic Fibrosis: Cystic fibrosis is an inherited disease that causes thick mucus to build up in the lungs, leading to repeated, serious lung infections. The Cystic Fibrosis Program at TGH is the largest adult program in the state certified and supported by the Cystic Fibrosis Foundation.

• Pulmonary Hypertension: USF Health pulmonologist Ricardo Restrepo-Jaramillo,MD, assistant professor of medicine, specializes in pulmonary hypertension – high blood pressure that occurs in the arteries that go from the heart to the lungs and may eventually lead to heart failure. He will become director of the new USF pulmonary hypertension program at TGH, Dr. Patel said.

Lung transplants are typically performed for people likely to die from lung disease within one to two years, when other treatments like medications or breathing devices no longer work, according to the National Heart, Lung and Blood Institute. ILD and cystic fibrosis are both conditions accounting for the most lung transplants nationwide, Dr. Patel said, with pulmonary hypertension affecting a smaller population of patients needing transplants.

Collaborating with community physicians

To create an integrated center, Dr. Patel plans to bring several pulmonologists with research as well as clinical expertise into the lung transplant program he directs, as well as recruit subspecialty directors for the ILD and cystic fibrosis programs. He will also add nurse practitioners to a team already supported by TGH nurse coordinators, respiratory therapists, social workers, dietitians and a pharmacist.

“When you manage patients with advanced lung disease, it takes a multidisciplinary team of professionals skilled in pre and post-transplant,” he said. “These are patients with complex conditions who need a lot of support and coordination,”

Dr. Patel sees patients at the Cardiac and Lung Transplant Clinic based at Harbourside Medical Tower.

More immediately, though, he is focusing on selectively increasing the referral base of patients by meeting with community physicians across the Tampa Bay region and seeing established pre-transplant patients in the clinic at Harbourside Medical Tower, Tampa General campus.

“I want doctors in the community to know that we are here to collaborate in the care of patients with advanced lung diseases,” Dr. Patel said. “Our availability is a priority, and ensuring the shortening of turn-around times for initial clinic visits is crucial, so that patients referred to the USF-TGH program are evaluated for medical care or transplant within weeks, not months. When someone needs a transplant, they need to be seen yesterday, and we work to intervene early.”

Advances in pulmonary transplant treatment

Over the last decade, advances in surgical techniques and significant improvements in post-operative care have contributed to improved survival of pulmonary transplant patients.

“We’ve gotten better at understanding what it takes to get these patients through transplants with fewer complications,” Dr. Patel said. “Once you get patients through the ICU following transplant, their chances of recovery and surviving a year or more out are much better.”

Medical therapy has also improved. For example, in 2014 the FDA approved the first medications (pirfenidone and nintedanib) to treat the most common type of pulmonary fibrosis, known as idiopathic pulmonary fibrosis (IPF). Until then, lung transplant was the only option for these patients, said Dr. Patel, who at Stanford led several site clinical trials testing the effectiveness of drugs for IPF.

Dr. Patel received his MD degree from the Medical University of Lublin in Poland. He completed a fellowship in pulmonary and critical care medicine at the University of Vermont and a dual heart-lung and lung fellowship at Stanford University Medical Center. He worked in private practice in Baltimore as well as holding faculty positions at the University of Vermont College of Medicine, the University of Maryland Medical Center, and Stanford.

Dr. Patel is a member of the American College of Chest Physicians and the International Society for Heart and Lung Transplantation.

A USF-TGH Center for Advanced Lung Disease won’t happen overnight. But Dr. Patel is confident that the vision can become a reality one purposeful step at a time.

“That’s why I came here,” he said. “We have a strong foundation and the pieces to grow.”

Photos by Eric Younghans, USF Health Communications and Marketing