The Remarkable Recovery of Kevin St. Clair

He didn’t travel much as a child, but as an adult, Kevin St. Clair, a 32-year-old engineer and self-described adventurist, travels every year to a new part of the world. Past trips included heli-skiing in the Canadian Rockies and chartering a sailboat to go Greek island hopping with friends.

But none of his journeys prepared him for his most recent trip, in late 2016, to South America. It began with seven days of sailing with friends and ended with St. Clair being medically evacuated from Colombia to the United States on a military C-130 transport plane. He had pneumonia so debilitating that his lungs, kidneys, and heart began to fail.

Kevin’s last memory of South America is leaving his friends at the Rio de Janeiro airport, where he boarded a flight headed for a solo visit to Colombia on Jan. 8, 2017. His next memory is waking up at NewYork-Presbyterian/Columbia University Irving Medical Center and seeing the date on a calendar: March 3.

“I was very confused,” he says. “It took me a few days to even understand where I was. But it was pretty clear when I woke up that I was in bad shape, just based on the number of tubes I had coming in and out of me.”

Pneumonia had ravaged his body.

“He had several organ systems that were barely hanging on,” says Dr. Matthew Bacchetta, the cardiothoracic surgeon who treated him at NewYork-Presbyterian/Columbia University Irving Medical Center. “It was quite apparent that his disease was very severe and could potentially require a lung transplant.”

After peeling off from the group in Brazil, Kevin had planned to explore Colombia alone before traveling to a friend’s wedding in Mexico. But in a text he doesn’t remember sending, he told friends he couldn’t meet them as planned.

“I pretty much have zero lung function,” he wrote. “I’m not going to make the wedding.”

The friends who’d seen Kevin becoming ill days earlier in São Paulo knew only that he’d taken their advice to find a hospital in Colombia. Unsure of Kevin’s location, another friend contacted his brother, Greg, who enlisted the help of the U.S. Department of State American Embassy in Bogota to track Kevin to a hospital in Medellín.

The next morning, Kevin’s parents, Scott and Judy, flew from Colorado to Colombia, arriving at 9:45 p.m. They struggled to communicate with Spanish-speaking doctors but saw that Kevin was on a ventilator and heavily sedated.

Kevin was transferred to another hospital in Medellín, where for about 30 days he was supported with extracorporeal membrane oxygenation (ECMO). ECMO support involves channeling blood into a pump and through an oxygenator, which infuses the blood with oxygen and removes carbon dioxide. The blood circulates through the body, keeping the patient alive when lungs are failing.

“Unfortunately, he did not improve enough to come off ECMO,” says Dr. Bacchetta, “and it also became quite apparent that he was going to need a higher level of care.”

Meanwhile, Judy’s cousin, a pulmonologist, contacted colleagues about Kevin’s condition in a search for American treatment centers. The family was connected to the U.S. Air Force, which arranged an aeromedical evacuation to the San Antonio Military Medical Center (SAMMC) in Texas, marking the first time, from what they were told, that the U.S. government had evacuated an American citizen out of Colombia.

By that time, Kevin’s lungs were failing so badly, he developed pulmonary hypertension — high blood pressure in the lungs that can lead to fatal heart failure. Air Force Lt. Col. Phillip Mason, a physician and the medical director of the Adult ECMO program at SAMMC, knew Kevin needed advanced care.

Dr. Mason called a friend from the Army: Dr. Bacchetta, the surgical director of the Adult ECMO program and the Pulmonary Hypertension Comprehensive Care Center at NewYork-Presbyterian/Columbia University Irving Medical Center. With one of the largest ECMO programs in North America, NewYork-Presbyterian has handled ECMO transports from as far as the Middle East.

“Everybody was in agreement that we needed to get here, that this was the best place in the world, literally, to treat what he needed to be treated for,” Scott says.

Within 48 hours of the call, Dr. Bacchetta and his team arrived at SAMMC, where they found Kevin “really about as sick as you could possibly be,” says Dr. Bacchetta. “His heart was failing. His lungs were failing. His kidneys were failing. We knew we had to do something rather quickly.”

The NewYork-Presbyterian ECMO program arranged to send a three-person team for an aeromedical evacuation in an equipment transport plane to New York City. A logistical puzzle with the highest of stakes, the slightest miscalculation of oxygen levels could cause Kevin’s death midair.

“It gets down to the nitty-gritty of planning details. ‘Do I have enough oxygen to fly this patient from Texas to New York?’” says Dr. Bacchetta.

Kevin arrived safely in New York on Feb. 25, 2017, but gravely ill. NewYork-Presbyterian/Columbia University Irving Medical Center assembled an expert team in ECMO, critical care, and pulmonary hypertension that met every day to discuss his care and progress, which was slow and precarious at times. Eventually, Kevin started to improve. Scott remembers witnessing a turning point in the intensive care unit as a doctor examined Kevin’s latest X-ray. The initial scan had shown his lungs almost completely obscured by the infection. This time, the doctor said excitedly, “I see lungs! I see lungs!” They were healing.

Kevin’s first recovery milestone was being removed from the ECMO machine. As his lung capacity improved, he transitioned from a ventilator to a tracheostomy collar that weaned him off oxygen.

One by one, the tubes disappeared. The blood test results improved. In April, Kevin went outside to see the sun. It was the first time he had been outdoors in months.

Physical therapy, which initially meant being lifted out of bed to simply sit in a chair, progressed to walking, climbing stairs, and riding a stationary bike. As Kevin worked to build muscle and endurance for three hours daily, Dr. Bacchetta found himself with increasingly less to say beyond, “You’re looking good.”

On May 28, more than four months after he became sick, Kevin was cleared to fly home to Denver with an oxygen concentrator to help him breathe at the increased altitude. His parents, who had temporarily moved to New York City and were by his side in the hospital, joined him.

With remnants of the infection restricting his lung capacity, he still experiences shortness of breath. Dr. Bacchetta is hopeful Kevin can return to an active lifestyle.

“I’m confident that Kevin is going to get the most out of whatever he has,” he says. “Where that leads to, I don’t know, but I look forward to seeing it.”

Kevin is now home in Colorado. He no longer needs regular oxygen support, and is able to enjoy short bike rides and hikes. He’s thankful for the NewYork-Presbyterian/Columbia University Irving Medical Center team that brought him back to health, from doctors who checked in even after he left the ICU and nurses who visited during rehab sessions.

“They’re incredible, and they saved my life,” Kevin says of the medical team. “I’ve never seen people truly care so much … it’s a very busy hospital, but they always put in the time and cared.”

Dr. Bacchetta insists the most important person in Kevin’s recovery wasn’t a doctor, nurse, or therapist. It was Kevin.

“We all like to pat ourselves on our backs because we feel we did such a great job. But you have to understand that Kevin recovered because of his own inner strength and constitution,” he says. “It is a remarkable recovery.”