Military Docs Use Cutting-edge Device to Save Patient
By Elaine Sanchez
Brooke Army Medical Center
JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas, Nov. 29, 2012 Doctors from San Antonio Military Medical Center here saved a young mother’s life last month using cutting-edge technology historically reserved for infants and young children.
Air Force Lt. Col. (Dr.) Jeremy Cannon, right, and Dr. Jeremy Pamplin place a patient on extracorporeal membrane oxygenation, or ECMO, in September 2012 at San Antonio Military Medical Center in Texas. ECMO is a heart-lung bypass system that circulates blood through an external artificial lung and sends it back into the patient’s bloodstream. Photo courtesy of U.S. Army Institute of Surgical Research
(Click photo for screen-resolution image);high-resolution image available.
The case marked the first time the medical center has treated an adult with extracorporeal membrane oxygenation, or ECMO, a heart-lung bypass system that circulates blood through an external artificial lung and sends it back into the patient’s bloodstream.
“This is a true success story,” said Air Force Lt. Col. (Dr.) Jeremy Cannon, the hospital’s trauma chief and a key player in the case. “I firmly believe this patient would not be here if it wasn’t for ECMO and a tremendous team effort.”
Cannon first heard of the case a few months ago, while he was in the midst of a surgery. He had asked to be paged whenever patients in the hospital developed severe lung injury so he could assess them for ECMO treatment.
The patient -- referred to as “Jane” in this article to protect her privacy -- woke up several days earlier with itchy, irritated eyes, but she and her doctor chalked it up to an infection or a virus. It wasn’t until her symptoms spread and worsened that she decided an emergency room visit was in order.
A few hours later, Jane was diagnosed with severe toxic epidermal necrolysis, or TENS, an autoimmune reaction to medication. She was flown by helicopter from her south Texas hometown to the U.S. Army Institute of Surgical Research’s Burn Center, the Defense Department’s only burn center, which is located in the medical center here.
The TENS progressed quickly, and by the time she reached the hospital, Jane’s skin was sloughing off, her lungs were filling with fluid and tissue, and her vital organs were failing. She was admitted to the Burn Center on Sept. 15 and initially was stabilized. However, when her condition worsened, Cannon was alerted.
Cannon and his ECMO team members had one thought after assessing Jane: “She’s going to die if we don’t use ECMO.”
Cannon and a select team of specialists had been training for this moment for more than a year, thanks to a Defense Department grant that provided ECMO supplies, training funds and equipment to explore the use of ECMO on adults.
ECMO is commonly used in neonatal intensive care units around the world on newborns with lung issues such as meconium aspiration, a medical condition that occurs when infants ingest their first stool before or during delivery. However, adult applications are much less common, mainly due to a lack of recent patient data.
Cannon, however, had been observing ECMO successes since his residency and strongly believed in its outcomes for adults, particularly for patients on the brink of death. He had transferred to SAMMC from the Air Force’s Wilford Hall Medical Center, which had the military’s only infant and child ECMO center, so he had ongoing exposure to the technology. Along with its experts, the neonatal ECMO center transferred to SAMMC last year.
Cannon said he brought his strong convictions about the lifesaving potential of the technology to his leadership and requested for Jane to be SAMMC’s first adult ECMO patient. “I’ve been involved in ECMO cases for 15 years,” he said. “I saw the benefit and felt confident we had the team structure and protocols in place.”
The same day she checked in, Jane was put on ECMO, and stayed on it for 23 days.
It was touch-and-go at first, Cannon noted. “It was agonizing for 22 of those 23 days,” he recalled.
Finally, on Day 21, Jane’s lungs started to clear, and two days later, staff transitioned her from ECMO to a standard ventilator. “Within a day and a half, she went from profoundly ill to greatly improved,” Cannon said, noting the team effort of experts across the hospital.
“It was exhilarating to see her get better, thanks to a concerted effort,” he added.
Maria Serio-Melvin, ISR nurse research consultant, also credited the procedure’s success to an “intense, collaborative, cooperative effort” between the ISR and ECMO teams.
A few weeks later, Jane is now an outpatient, staying with her mother in town until she gains enough strength to return home. “It’s been tough, but I’m not going to give up,” Jane said in a recent interview at the hospital. “I can’t say enough about the care I’ve received here.”
Jane’s lungs and skin are still healing, but Cannon said he has high hopes for his patient, as well as for other SAMMC patients who can be helped through ECMO.
Cannon also said he hopes to see an increased use of adult ECMO in the war zone, where it’s already proved lifesaving for several troops. In 2010, an ECMO-trained team picked up a soldier in Kandahar, Afghanistan, who had been shot in the chest. His right lung had to be removed, a procedure that typically carries a 100 percent mortality rate. However, the lung team placed him on ECMO and he quickly recovered in a hospital in Germany.
Cannon recalled meeting this patient a few weeks after he arrived at SAMMC. “He’s married now and enjoying life,” he said. Since then, there have been five ECMO transports from the battlefield to Germany, he added.
Cannon said his long-term vision is to see ECMO patients transported directly from the battlefield to a stateside location, such as the medical center here, for their recovery.
“We’ve proven we can very safely take care of even most critically ill patients, and I’m very optimistic we’ll be able to offer these services to wounded warriors throughout their continuum of care,” he said.
Based on recent successes around the nation, Cannon said, he expects to see a resurgence in ECMO research around the world, which will help to build confidence in the technology for adults. A trial with strict research protocols based in France is now under way and promises to answer some of the unknowns that remain about the use of ECMO in adults, he noted.
Whatever the future holds, Cannon said, he’ll never forget the lifesaving impact of ECMO for Jane. “All of this came together beautifully, and it worked,” he said. “She’s alive because of an amazing team effort.”
The day she improved, he added, “was the pinnacle day in my medical career.”