LANDSTUHL, Germany — Flying sick and injured American troops from Ramstein Air Base to the States has become routine after 12 years of war, but the evacuation of a military spouse last week was different: it was the first trans-Atlantic flight of an adult patient hooked to an external lung, Air Force medical personnel said.
The patient, the wife of a U.S. soldier stationed in Germany, may require a lung transplant, which medical personnel said would likely be easier to arrange in the U.S.
Her evacuation, according to her medical team, was the longest ever of a patient on extracorporeal membrane oxygenation – or ECMO – a therapy that a handful of military medical personnel have spent more than half a decade mastering.
“Ultimately, our reason for existence is to be able to apply this to combat casualties that have early respiratory failure,” said Lt. Col. Jeremy Cannon, chief of trauma surgery at the San Antonio Military Medical Center in Texas, where he also heads the hospital’s ECMO team. “But everyone else in the [Department of Defense] community benefits.”
“This particular mission is gratifying on many levels,” said Lt. Col. David Zonies, chief of trauma and critical care at Landstuhl Regional Medical Center and head of the Air Force’s Acute Lung Rescue Team.
The seeds of Wednesday’s flight were planted at Landstuhl more than half a decade ago as American casualties from the wars in Iraq and Afghanistan mounted. Because of the low cabin pressure at high altitude, standard medical evacuation flights can’t carry personnel with severe lung illness or damage, said Maj. Michelle Langdon, the lead registered nurse for the lung team.
Before the lung team’s creation, she said, those patients faced two possible outcomes: “They would sit in Bagram [Afghanistan] until they either, One: got better or, Two: they died.”
Air Force medical personnel at Landstuhl created the deployable lung team in 2005 to give those patients a better shot at survival, but it was still another five years before the team added ECMO to its bag of lifesaving tools.
Their first such rescue came in late 2010, a measure of last resort taken after high-tech ventilators failed to raise a wounded soldier’s oxygen levels to a level safe for air transport.
Tubes were inserted into veins in his groin and jugular and hooked to the ECMO device, which pumps blood from the body, strips it of carbon dioxide and infuses it with oxygen before pumping it back into the patient.
On the machine, Pvt. Eric Griego made it from Kandahar Airfield in Afghanistan to Germany, where he was transferred to a German hospital in Regensburg, a world leader in the development of ECMO devices and therapies for adults.
Landstuhl, the first stop for virtually every American servicemember evacuated from Afghanistan, is capable of stabilizing most patients for transfer to stateside hospitals.
“But we don’t have the assets here at Landstuhl to maintain a patient on ECMO,” Langdon said. “It’s a very labor-intensive and people-intensive function.”
Until Wednesday, any ECMO patient evacuated to Landstuhl would have been transferred to Regensburg.
Regensburg, though, is not a trauma center, and the military has been working to establish its own long-term ECMO facility at San Antonio Military Medical Center, a level-1 trauma hospital that also houses the military’s burn center.
San Antonio treated its first ECMO patient in October, and had four more before Wednesday. In May, it was officially recognized as the Defense Department’s ECMO center of excellence, Cannon said.
“It’s really been a labor of love for over two years for me,” he said of the center’s creation.
The center is now capable of managing at least one adult ECMO patient at a time, Cannon said, and the long-term plan is for San Antonio to take in all such patients from the military community around the globe.
“But the one component that has been missing in this chain of care has been long-range strategic evacuation of these patients on ECMO,” he said.
The Landstuhl lung team has almost three years experience with those evacuations, moving six patients on ECMO out of Afghanistan last year alone. Those flights are roughly eight hours long.
A team of four from Landstuhl, including Zonies and Langdon, flew Wednesday’s mission with four members of the San Antonio team led by Cannon.
They successfully transferred the Army wife to San Antonio — an 11-hour direct flight on an Air Force C-17 — without complications, a Landstuhl spokeswoman said.
That success certified the San Antonio team to pick up ECMO patients overseas and evacuate them to the U.S.
The decision to move the Army wife came the week before her evacuation, after she’d spent four months in German hospitals with a persistent lung infection, her husband said. Six days before her evacuation, German doctors in Würzburg put her on ECMO as her condition deteriorated.
“There is a remote possibility that she would need lung transplantation,” Cannon said. “And it’s very difficult to be listed for lung transplant. It takes a long time to rise through the list here in Europe. So to give her the best opportunity of having a complete evaluation for what her underlying problem is and maintaining the option of a lung transplant should she need it, we felt that it was best to bring her back to the U.S.”
The soldier and his wife asked that they not be identified so as not to alarm family and friends, who are unaware of the severity of her illness.
About an hour before the flight Wednesday, the soldier said, “About every emotion you can think of, she’s feeling it at the moment.”
Since the Army wife’s illness began, her husband said, his unit has done everything it could to accommodate his family, placing him on permanent duty at his wife’s bedside. He’s received a compassionate reassignment to Texas to be with his wife, and his unit is arranging to have their belongings moved.
“We’re nervous, but excited that the technology is available for soldiers and spouses alike, and that they care as much for the family members as they do for soldiers,” he said. “Because she’s getting the exact same support that they would give to any soldier.”