Military Advances Medical Technology to Save Lung Patients
Dana Crudo | Health.mil
August 07, 2013
The evacuation of a military spouse on external lung support across the Atlantic last month would have been just a flight of fancy a few years ago.
The Army wife was treated with extracorporeal membrane oxygenation by a team of Army and Air Force doctors and nurses during the 11-and-half-hour flight from Germany to San Antonio, Texas. The medical mission marks the first trans-Atlantic flight of an adult patient on the oxygenation therapy.
This recent achievement has been years in the making and reflects the hard work military medical personnel have done to adapt this therapy for use with combat casualties.
"This is what we have been working on for three years now, almost nonstop," said Air Force Lt. Col. Jeremy Cannon, M.D., chief of trauma surgery at the San Antonio Military Medical Center. "This incredibly hard work is paying off."
Extracorporeal membrane oxygenation is a therapy that uses an external, artificial lung to do what a lung normally does for patients who have severe lung damage or disease. The compact device drains blood out and removes the carbon dioxide, then puts oxygen back into the blood and returns the blood back to the body.
The treatment "is a high-risk, high-stakes endeavor," said Cannon. "It requires a specialized team that knows what [they’re] doing."
History in the Making
Traditionally, extracorporeal membrane oxygenation is primarily used on infants. It is also used on youngsters who are so sick that a mechanical ventilator will not work.
Military medical personnel have upped the ante within the past decade, using the oxygenation therapy to save the lives of wounded combat troops who are airlifted.
The Landstuhl Regional Medical Center in Germany, and Tripler Army Medical Center in Hawaii, have created specialized transport teams, and the San Antonio Medical Center in Texas, opened the first facility focused on extracorporeal membrane oxygenation within the Department of Defense.
Landstuhl Regional Medical Center
Air Force Col. Warren Dorlac and his wife Lt. Col. Gina Dorlac, former doctors at Landstuhl Regional Medical Center in Germany, created the first deployable acute lung rescue team there in 2005.
Before that, military medical personnel could not transport service members with severe lung damage since they might not get enough oxygen when the plane experienced low cabin pressure at high altitudes.
According to Air Force Lt. Col. David Zonies, chief of trauma and critical care at Landstuhl Regional Medical Center, these patients had two options: "They remained in theater to recover enough to be safely transported, or they died in theater."
In 2010, extracorporeal membrane oxygenation was added to the Landstuhl lung team’s lifesaving equipment after Warren Dorlac recognized the need for the therapy while deployed in Iraq.
The first successful transport of an adult patient using the therapy by the Landstuhl lung team occurred in late 2010, when a wounded soldier was transferred from Afghanistan to Germany.
Last year, of the 18 missions the Landstuhl lung team did, six patients needed extracorporeal membrane oxygenation. Patients are not limited to Americans either. They also include British and Italian service members involved in NATO missions, Zonies said.
"We have the greatest experience of downrange transport of anyone in the world," Zonies said. "Survivability of these patients is 16 to 70 percent depending on where you are in the U.S. We have 90 percent."
San Antonio Medical Center
Cannon, who was deployed with Warren Dorlac in Iraq, recognized the need for the oxygenation treatment in combat as well. He saw that the military had no adequate way of transporting patients who needed something more than a ventilator all the way back to the U.S.
"Once a month, an Air Force medical team would fly a really sick soldier who was unstable on a ventilator," Cannon said. "They were doing this on a wing and a prayer."
Cannon returned to San Antonio Medical Center after his deployment to advocate for the creation of an extracorporeal membrane oxygenation facility.
The Landstuhl and Tripler lung teams can transport these patients, but their medical centers are not equipped to care for them. The San Antonio Medical Center provided the missing link.
Landstuhl and Tripler "don’t have [the] capacity to sustain patients more than a couple days," Cannon said. "We have enough expertise, staff and resources to support an ECMO patient."
In May 2013, the San Antonio Medical Center became the first extracorporeal membrane oxygenation center of excellence officially recognized by the Department of Defense. The center treated its first patient in October 2012 and has treated four others in the past eight months.
It All Comes Together
"The vision was to seamlessly move patients from anywhere in a combat zone to one of our Department of Defense centers," Zonies said.
This vision became a reality last month with the trans-Atlantic flight of the Army wife. She had been experiencing progressive breathing problems over the past year while her husband was stationed in Germany and needed the specialized medical attention that the San Antonio Medical Center could provide. Doctors there are currently working on identifying the underlying cause of her lung problems.
"This has now proven that we can move such critically ill patients … anywhere on the globe," Zonies said. "It is an important step forward in clinical care and medicine."
Making an Impact in the Civilian Medical World
The recent success with extracorporeal membrane oxygenation is a testament to the dedication of military medical staff.
Its use on military evacuation flights brings to light how the technology can be used in the civilian world.
"It is probably one of the lessons the military can give back to the civilian medical world by showing the success and possibilities of ECMO," Zonies said. "The technology should become part of the standard of care for critically ill patients, not just in the military system, but worldwide."