Medical Team Achieves Cutting-edge Patient Transfer
February 6, 2013
Marking a first for military medical care in the United States, an Army and Air Force team successfully transported a critically ill woman on a form of heart-lung bypass from San Antonio Military Medical Center to New York City last month.
This mission marked the military's first stateside transport of an adult patient on extracorporeal membrane oxygenation, or ECMO, noted Air Force Lt. Col. (Dr.) Jeremy Cannon, SAMMC's trauma chief. ECMO is a heart-lung bypass system that offers a lifesaving capability for patients who aren't doing well on a ventilator, he explained.
While the technology has been used to aid ill infants and pediatric patients for about 30 years, it's only recently been shown to have lifesaving capabilities for adults, Cannon noted.
This case involved a woman in her early 30s with cystic fibrosis. She had developed viral and bacterial pneumonia that made her "incredibly ill to the point where she could no longer be safely managed on a ventilator," the doctor recalled.
After stabilizing this young mother of two and wife of an active-duty Army recruiter on ECMO, the trauma chief called on the Institute of Surgical Research Burn Flight Team and the hospital's ECMO team, as well as the 59th Medical Wing's Critical Care Air Transport Team to evacuate her to a center with expertise in using ECMO as a bridge to a lung transplant. This mission creatively brought together a group of Army and Air Force physicians, nurses and respiratory specialists for this critical patient, Cannon said.
Joined by a transplant surgeon and a perfusionist from Columbia University, the team transported the patient via ambulance from the Burn Center to the Kelly Field flight line, where they boarded a C-17 en route to the John F. Kennedy International Airport. Once in New York, an ambulance transported the patient to the New York-Presbyterian Hospital.
"Since her transport now just over two weeks ago, she has made a remarkable recovery to the point where she may be able to come off of ECMO soon and is able to respond to her husband who is still at her bedside," Cannon said.
Nearly two years of hard work and preparation paid off that night, the doctor said, noting the patient "definitely wouldn't have made it without ECMO."
This patient is the third adult to be placed on ECMO at SAMMC. The first patient, also a young mother, was on this therapy for 23 days while her lungs healed from an autoimmune reaction. She's now back home with her family and doing well, Cannon said.
Cannon said he has high hopes for BAMC's ECMO program, particularly for wounded warriors critically injured in theater. He'd like to see ECMO patients transported directly from the battlefield to SAMMC where they can receive state-of-the-art trauma and ECMO care. "The idea would be to rendezvous in Germany and bring patients back to SAMMC for ongoing care even while on ECMO," he said.
The doctor's vision is for BAMC, and San Antonio, to become DoD's Extracorporeal Life Support epicenter -- for beneficiaries and combat wounded.
"It's an amazing capability, and we're just tapping into the tip of the iceberg," he added. "ECMO offers us untold potential to intervene in situations that would have been deemed hopeless a few years ago."
This most recent case is a perfect example, he said. "It's just incredibly heartening when all the time and effort and energy and thought put into it pays off in huge ways."
Speaking on behalf of the entire team that accomplished this mission, Cannon noted that the feeling of reward after a positive outcome is "hard to describe."