LANDSTUHL, Germany -- A U.S. team for the first time in a combat evacuation has used an innovative and portable heart-lung machine, saving a 22-year-old soldier wounded in Afghanistan.
The soldier had been shot in the chest, and a bullet had shredded his lungs.
That’s when Dr. (Lt. Col.) Sandra Wanek got the call. The trauma surgeon led this week’s medevac mission out of Afghanistan as part of Landstuhl Regional Medical Center’s Lung Rescue Team, which flies to combat zones to treat servicemembers with the most serious lung injuries and evacuate them to Germany.
Within hours, Wanek and her team were bound for Kandahar.
When they got there Wednesday, they operated on him for five hours and tried several different ventilators, but all of them failed.
“I just could not improve his oxygenation to the point where it was safe to fly,” Wanek said.
After missing an evacuation flight and doing one more hour of surgery, Wanek chose to use the device — known as an extracorporeal membrane oxygenation (ECMO) machine — for the first time.
The machine, developed in Germany, forces the patient’s blood through an artificial membrane that lets oxygen in and takes carbon dioxide out.
“It takes the place of your lungs,” Wanek said Thursday in the intensive care unit at Landstuhl, where the soldier was being treated. “We are removing all the CO2 from his body and giving him all the oxygen he needs. I don’t have to count on his lungs to do anything.”
Without it, she said, the soldier would likely have died.
The flight out of Afghanistan on Wednesday was the first time the machine, not much bigger than a suitcase, was used while transporting a patient out of a combat zone.
“This is the most exciting thing I’ve ever done in the Army,” Wanek said, looking at her unconscious patient. “It’s the most desperate feeling in the world to have someone who is young and whose wounds are survivable and know that I have nothing I can do for him. But now I do. And it’s small enough; it’s transportable; and it’s safe.”
The soldier, whose name was not released, was flown Thursday from Landstuhl to the university hospital in Regensburg, Germany, where the heart-lung machine was first developed and where doctors have particular expertise with it.
It’s also where German doctors trained Wanek and her team on how to use the ECMO, before it was brought to Afghanistan.
“We trained in July, and this is the first person who needed it,” she said.
Extracorporeal membrane oxygenation was developed in the 1980s as a way to save the lives of premature infants with underdeveloped lungs. Later, doctors began to use the machines on adults with lung failure, most recently with H1N1 influenza patients.
The early machines, however, were too big and heavy — more than 200 pounds — to be used in transit, such as from an accident scene, so a lighter and more compact device was developed.
In 2006, Regensburg doctors started taking the compact machines on rescue flights and ambulances to treat patients with severe lung injuries, such as from gunshot wounds or stabbings, or acute respiratory illness. They have transported about 70 patients hooked up to the machines.
Unlike a ventilator, which pushes air into the lungs, the ECMO machine bypasses the lungs entirely. The machine, which costs about $300,000, has the approval of the U.S. Food and Drug Administration, though it’s not used stateside to treat patients in transit, Wanek said.
The machine connects to blood vessels in two places: the groin and the jugular vein. Wanek recalled how nervous she was in Afghanistan when she had to unclamp the veins and let the soldier’s blood flow through the tubes.
“I had not felt my heart beat that hard in a long time,” she said.
The machine worked even better than she expected, and by the time the team landed at Landstuhl several hours later, the soldier’s condition had started to improve, said Air Force Maj. Clayne Benson, another anesthesiologist on the lung rescue team.
Dr. Alois Philipp — one of the developers of the machine — accompanied the soldier back to the Regensberg hospital. Philipp will care for the soldier until his lung injuries heal and he is healthy enough to return to Landstuhl.
When the soldier does return, Wanek hopes to hand the young man a scrapbook of photos so that he can see all that was done to keep him alive.
“He’s a history-making soldier,” she said, “and he doesn’t know it yet.”